EVIDENCE-BASED CLINICAL MEDICINE Is Your Depressed Patient Bipolar?

Accurate diagnosis of mood disorders is critical for treatment to be effective. Distinguishing between major depression and bipolar disorders, especially the depressed phase of a bipolar disorder, is essential, because they differ substantially in their genetics, clinical course, outcomes, prognosis, and treatment. In current practice, bipolar disorders, especially bipolar II disorder, are underdiagnosed. Misdiagnosing bipolar disorders deprives patients of timely and potentially lifesaving treatment, particularly considering the development of newer and possibly more effective medications for both depressive features and the maintenance treatment (prevention of recurrence/relapse). This article focuses specifically on how to recognize the identifying features suggestive of a bipolar disorder in patients who present with depressive symptoms or who have previously been diagnosed with major depression or dysthymia. This task is not especially time-consuming, and the interested primary care or family physician can easily perform this assessment. Tools to assist the physician in daily practice with the evaluation and recognition of bipolar disorders and bipolar depression are presented and discussed. (J Am Board Fam Pract 2005;18:000–000.)