Bipolar depression: the clinical characteristics and unmet needs of a complex disorder

Abstract

Objective: We reviewed important clinical aspects of bipolar depression, a progressive psychiatric condition that is commonly treated in primary care. Bipolar depression is associated with considerable burden of illness, high suicide risk, and greater morbidity and mortality than bipolar mania. Methods: We identified articles relevant to our narrative review using a multistep search of the literature and applying terms that were relevant to bipolar depression or bipolar disorder. Results: Bipolar depression accounts for the majority of time spent unwell for patients with bipolar disorder; high rates of morbidity and mortality arise from full symptomatic episodes and interepisode subsyndromal symptoms. Bipolar depression is an important contributor to long-term dysfunction for patients with bipolar disorder due to psychosocial impairment, loss of work productivity and high rates of substance abuse. Missed and delayed diagnosis is prevalent due to overlapping symptoms with unipolar depression and other diagnoses. Medical comorbidities (i.e. cardiovascular disease, hypertension, obesity, metabolic syndrome) and psychiatric comorbidities (i.e. anxiety disorder, personality disorder, eating disorder, attention-deficit/hyperactivity disorder) are common. Currently, only three treatments are FDA-approved for bipolar depression; monotherapy antidepressants are not a recommended treatment option. Conclusions: Bipolar disorder is common among primary care patients presenting with depression; it is often treated exclusively in primary care. Clinicians should be alert for symptoms of bipolar disorder in undiagnosed patients, know what symptoms probabilistically suggest bipolar versus unipolar depression, have expertise in providing ongoing treatment to diagnosed patients, and be knowledgeable about managing common medication-related side effects and comorbidities. Prompt and accurate diagnosis is critical. ARTICLE HISTORY

S100A6 and Its Brain Ligands in Neurodegenerative Disorders

“…It is worth mentioning that global gene expression profiling using whole-genome microarrays has shown that CacyBP/SIP is up-regulated in another neurological disorder, that is, bipolar disorder (BD) [70]. BD is a severe neurological condition, the characteristic features of which include unusual shifts in: Mood, activity, concentration, and the ability to carry out day-to-day tasks [71]. The causes of BD are not fully understood and, thus, the possibilities of treatment of patients suffering from this disease are limited.…”

In vivo phenotyping, mechanism‐informed treatments, domain‐based psychopathology and nomological networks: A strategy for treatment discovery and development in bipolar depression

“…A concatenation of study findings published during the last decade have brought into cold clarity the predominance and debilitating nature of depressive symptoms in adults with bipolar disorders (BD). For example, results from longitudinal, naturalistic studies in BD have concluded that for the majority of affected individuals, depressive symptoms manifest as “polarity first” and “polarity predominant” 1 . A separate body of literature indicates that the depressive symptoms of the adult with BD are the principal quality of life of detractor, mediator of psychosocial and workplace impairment, and identified by persons with life lived with BD as a priority therapeutic target.…”

Possibility of a New Indication for Amantadine in the Treatment of Bipolar Depression—Case Series Study

“…Bipolar disorder type I (BD-I) is a disabling and cyclical mental illness whose essence is mood instability, manifested by recurrent episodes of bipolar depression, mania, and mixed states. In addition to these primary symptoms, BD-I causes chronic symptoms in the form of emotional dysregulation, sleep disturbances, cognitive impairment, and subsyndromal mood disturbances between the episodes [ 1 ].…”

“…BD-I affects about 2% of the general population; the course of the disease is individual and may differ in severity, duration, and frequency of occurrences [ 1 , 2 ]. Characteristic for BD-I is a longer duration of depressive episodes than of manic episodes.…”