Bipolar depression: clinically missed, pharmacologically mismanaged

Abstract

Bipolar affective disorders are common and frequently debilitating mental illnesses. Diagnostic criteria mean they are defined by the presence of pathological mood elevation, but research shows greater disease burden is inflicted by depressive phases (bipolar depression) both in terms of duration and impact of symptoms. Despite this there is consistent evidence for the underdiagnosis of bipolar depression and its misdiagnosis as a unipolar disorder, with significant subsequent impact on medication management. There is currently less robust evidence for the appropriate pharmacological approach in such individuals than in unipolar depression, and fewer guidelines for clinicians. Despite this there is clear and growing evidence that 'treatment as usual' of depressive symptomatology is ineffective at best, harmful at worst, and that there is little role for the use of antidepressants. Both mood stabilizers and antipsychotics demonstrate efficacy, and whilst there are emerging data on intraclass differences, more research is needed, particularly concerning bipolar II disorder. Present treatment strategies are limited by insufficient large randomized control trials, an inadequate understanding of the neuropathology of bipolar illnesses and a lack of tailored medications. Better clinical training, understanding and recognition of this common condition are essential.

Cultivation of mushrooms for production of food biofortified with lithium

“…Over the years, a number of psychopharmacological agents have been introduced, with lithium (Li) cation being one of the most promising and effective, primarily in the recovery of bipolar affective disorder [1]. However, its potential therapeutic application spectra are much wider with evidence supporting its use in the treatment of unipolar depression [2], acute mania and its prophylactic [3,4], or reduction in suicidal and aggressiveness rates in affective disorders [5,6] and conduct disorder [7].…”

Lithium: the pharmacodynamic actions of the amazing ion

“…It is also efficacious in the treatment of unipolar depression [Coppen, 2000], particularly as augmentation therapy in severe refractory depression [Bauer et al 2003b;Kennedy and Paykel, 2004], and bipolar depression [Lloyd et al 2011]. In addition, it has been noted to effect aggressiveness [Jones et al 2011], reduce suicide rates in affective disorders [Tondo and Baldessarini, 2000;Cipriani et al 2005] and, more speculatively, has been considered as a possible therapeutic agent for treating chronic neurodegenerative diseases such as Alzheimer's, Parkinson's and Huntington's diseases [Marmol, 2008;Dudev and Lim, 2011].…”

The borderline of bipolar: opinions of patients and lessons for clinicians on the diagnostic conflict

“…Both BPD and BPAD are common mental health conditions, affecting 4–12% (BPD) 21 and 1–4% (BPAD) 22 of the population, and of course they can occur comorbidly. 23 For professionals there are apparent similarities between them, and several recent systematic reviews have explored this topic.…”