In bipolar disorder, depression is often the neglected stepchild. Mania gets more attention, perhaps because it presents so dramatically. Imagine two bipolar patients in an emergency room: one withdrawn and depressed, sitting quietly, and another ranting and pacing the room. Which one would be seen first?
Whether you work in a hospital or an office setting, you’ve probably seen many patients who come to you with a “history of bipolar disorder.” We’ve seen it, too, in multiple settings at an academic medical center. Is this a new epidemic? Or a redefinition of what it means to be “bipolar”?
Most of you would hesitate to put a patient with bipolar I on antidepressants without adding a mood stabilizer, in order to prevent a switch to mania. If this is your clinical practice, you are following the recommendations of the APA consensus guidelines for the treatment of bipolar depression. But the hard data to support the danger of switching is surprisingly weak.
Several past studies have investigated a possible link between infections during pregnancy and psychiatric illness in the offspring. These studies may be biased, however, by poor recall or by a clinical, as opposed to serological, diagnosis of infection in the mother. A recent study attempted to overcome this bias by measuring influenza antibodies—a more precise manner of identifying influenza exposure—drawn from the mothers of bipolar offspring.
Some patients complain bitterly about depression and dysphoria, but they don’t tell you anything about the other half of their lives—the upswings of mood and energy—so you may not realize the need to suspect bipolar illness.
Editor-in-Chief:Steve Balt, MD is a psychiatrist in private practice in the San Francisco Bay area.
Ronald C. Albucher, MD, is the director of counseling and psychological services and clinical assistant professor of psychiatry, Stanford University in Palo Alto, CA.
Richard Gardiner, MD, is a psychiatrist in private practice in Potter Valley, CA.
Alan D. Lyman, MD, is a child and adolescent psychiatrist in private practice in New York City, NY.
James Megna, MD, PhD, is the director of inpatient psychiatry and an associate professor of psychiatry and medicine at SUNY Upstate Medical University in Syracuse, NY.
Robert L. Mick, MD, is a contract physician in addiction medicine and military psychiatry in Bloomfield, NY.
Michael Posternak, MD, is a psychiatrist in private practice in Boston, MA.
Glen Spielmans, PhD, is an assistant professor of psychology at Metropolitan State University in St. Paul, MN.
Marcia L. Zuckerman, MD is director of Psychiatric Services at Walden Behavioral Care in Waltham, MA.
All editorial content is peer reviewed by the editorial board. Dr. Albucher, Dr. Gardiner, Dr. Goldberg, Dr. Lyman, Dr. Megna, Dr. Mick, Dr. Posternak, Dr. Spielmans and Dr. Zuckerman have disclosed that they have no relevant financial or other interests in any commercial companies pertaining to this educational activity. Dr. Balt discloses that his spouse is employed as a sales representative for Otsuka America, Inc.