Diagnosis and Pharmacotherapy of Bipolar Disorder

Abstract

Bipolar disorder often develops with depressive symptoms. At first onset, it can not be readily distinguished from unipolar depression. However, whereas the latter is treated with antidepressants, the former typically requires mood stabilizers. Therefore, the concomitant use of antidepressants is ineffective and destabilizing, leading to mood swings. The concept of bipolar spectrum disorder proposed by Ghaemi is useful for differentiating bipolar and unipolar depression. Particularly in cases with a family history of bipolar disorder or hypomania/mania induced by antidepressants, identifying latent bipolar disorder can be facilitated by attention to signs suggesting bipolar disorder (bipolarity) : hyperthymic personality, early age of onset, recurrent major depressive episodes, brief major depressive episodes, atypical depressive symptoms, psychotic major depressive episodes, postpartum depression, attenuated effects of antidepressants, and lack of response to adequate antidepressant trials.