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Bipolar depression: an unmet need in bipolar disorder. (Advertisement).

Although bipolar disorder covers a spectrum of mood episodes, research and treatments have focused more on mania than on depression. (1) Currently approved mood stabilizers--standard first-line regimens for bipolar disorder-- target mania rather than. (1,2) To date, there is no FDA-approved medication for the treatment of bipolar depression. Because patients with bipolar disorder often are hospitalized during severe manic episodes, clinicians are very familiar with the hazardous features of mania. However, depressive episodes also can be a significant clinical challenge. (2,3)


Depressive episodes in bipolar disorder can account for up to 80% of all mood episodes during the later decades of a patient's life. (4) These episodes often last longer than manic episodes and can be more dangerous and more challenging to treat. (2,4) Depressive states are also the most lethal in bipolar disorder, with the vast majority of suicides attempted during these states. (5) Yet, until recently, treatment of bipolar depression received minimal attention. Bipolar disorder affects approximately 1.2% of American adults, or more than 2.2 million people. (2) However, due to the high rate of misdiagnosis, the actual incidence of bipolar disorder may be even higher. (3)


Misdiagnosis remains one of the major treatment challenges in bipolar disorder. During episodes of mania or hypomania, patients tend to experience "highs" or intense bursts of energy. It may not be until the depressive episodes occur that many patients seek treatment. According to a recent survey conducted by the National Depressive and Manic-Depressive Association (NDMDA), a majority of bipolar patients-69% (411/600)-reported they had been misdiagnosed. (3) Of these, a majority (60%) were diagnosed with unipolar depression. (3)


The Mood Disorder Questionnaire (MDQ) is the first screening tool created specifically to help differentiate bipolar disorder from other mood disorders. It is a 13-item checklist that addresses symptoms, co-occurrence, and severity of outcome. The MDQ has a high rate of accuracy and is able to identify 7 out of 10 people who have bipolar disorder, which may help reduce the rate of misdiagnosis and its associated risks. (6) To access the MDQ online, visit


Bipolar depression is an illness in need of attention. The high rates of misdiagnosis are a constant reminder of the need for awareness. Creating new diagnostic tools and understanding the factors that differentiate unipolar depression from bipolar depression may reduce the rate of misdiagnosis and its associated risks.

Bipolar depression also can be more pervasive and potentially more dangerous than bipolar mania. Bipolar disorder is one of the most lethal psychiatric illnesses. (2) Although patients with bipolar disorder are often hospitalized during severe manic episodes, patients experiencing depressive episodes are at a higher risk of suicide, since suicides in bipolar disorder occur more often during depressive episodes. (5)

There remains a significant, unmet need in the treatment of bipolar disorder. More research is needed to provide safe and effective treatments for bipolar depression.



(1.) Calabrese JR, Ketter TA. Stabilization of mood from below versus above baseline in bipolar disorder: a new nomenclature. J Clin Psych. 2002;63:146-157.

(2.) Sachs GS, Printz DJ, Kahn DA, Carpenter D, Docherty JP. The expert consensus guideline series: medication treatment of bipolar disorder. Postgrad Med Special Report. 2000(April):1-104.

(3.) National Depressive and Manic-Depressive Association. Perceptions and impact of bipolar disorder: how far have we really come? Presented at Fourth International Conference on Bipolar Disorder; June 14-16, 2001; Pittsburgh, Pa.

(4.) Kraeplin E Manic-depressive Insanity and Paranoia. Edinburgh, Scotland: E & S Livingstone; 1921:169.

(5.) Dilsaver SC, Chen Y-W, Swann AC, Shoaib AM, Tsai-Dilsaver Y, Krajewski KJ. suicidality, panic disorder and psychosis in bipolar depression, depressive-mania and pure-mania. Psychiatry Res. 1997;73:47-56.

(6.) Hirschfeld P.. Williams JB, Spitzer RL, et al. Development and validation of a screening instrument for bipolar spectrum disorder: the mood disorder questionnaire. Am J Psychiatry. 2000;157;1873-1875.
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Publication:Clinical Psychiatry News
Geographic Code:1USA
Date:Jun 1, 2002
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