The management of bipolar disorder in primary care: A review of existing and emerging therapies

Abstract

Recent evidence suggests that the prevalence of bipolar disorder is as much as fivefold higher than previously believed, and may amount to nearly 5% of the population, making it almost as common as unipolar major depression. It is, therefore, not unrealistic to assume that primary care or family physicians will frequently encounter bipolar patients in their practice. Such patients may present with a depressive episode, for a variety of medical reasons, for longer-term maintenance after stabilization, and even with an acute manic episode. Whatever the reason, a working knowledge of current trends in the acute and longer-term management of bipolar disorder would be helpful to the primary care physician. In addition, an understanding of important side-effects and drug interactions that occur with drugs used to treat bipolar disorder, which may be encountered in the medical setting, are paramount. This paper will attempt to review existing and emerging therapies in bipolar disorder, as well as their common drug interactions and side-effects.

Diagnosing bipolar disorder in trauma exposed primary care patients

“…A large number of people with BD are frequently misdiagnosed with unipolar depression in the primary setting. Misdiagnosis may be due in part because they often present during depressive phases of the disorder rather than the manic (21). Piver and colleagues (22) found that up to 30% of the patients who present to primary care clinics as depressed and/or anxious actually have a bipolar spectrum disorder.…”

“…Piver and colleagues (22) found that up to 30% of the patients who present to primary care clinics as depressed and/or anxious actually have a bipolar spectrum disorder. Consequently, they are often treated with antidepressants alone which may have adverse affect on BD sufferers (21). Thus, the MDQ may still be clinically useful in the primary care setting for both African Americans and those with trauma histories only as a screen for those with possible bipolar disorders.…”

Bipolar disorder: Etiology, diagnosis, and management

“…Stressful events in everyday life in a patient with BD have been associated with a prolonged recovery time from either a depressive or manic episode. Thus, problem solving and establishing routines with regular sleep/wake cycles through cognitive behavioral therapy can not only assist in medication adherence but can also result in decreased hospitalizations (Berk, Dodd, & Berk, 2005). Another useful psychotherapy intervention is interpersonal and social rhythm therapy.…”

Impact of an educational program on the management of bipolar disorder in primary care

“…In primary care, many bipolar depressed outpatients receive an incorrect diagnosis of unipolar major depression because they spend more time in the depressed phase than in the manic phase (1–4). This is particularly common with past hypomania (bipolar II disorder), where patients usually present for treatment of depression and not for hypomania (which is often a pleasant period of overfunctioning).…”

“…Conclusion: A well-designed education package on diagnosis and management of bipolar disorder greatly increased the likelihood of physicians correctly assigning a subtype, namely bipolar I or bipolar II disorder, to patients already perceived as having some form of bipolar illness, and to prescribing mood stabilizers instead of antidepressants to these patients. In primary care, many bipolar depressed outpatients receive an incorrect diagnosis of unipolar major depression because they spend more time in the depressed phase than in the manic phase (1)(2)(3)(4). This is particularly common with past hypomania (bipolar II disorder), where patients usually present for treatment of depression and not for hypomania (which is often a pleasant period of overfunctioning).…”