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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by Phillipa on August 8, 2011, at 20:45:16
Before a doc should prescribe antidepressants patients should be screened family history wise and other. Phillipa
From Medscape Medical News
Bipolar Disorder Underlying Major Depression May Be Missed
Laurie Barclay, MDAuthors and Disclosures
August 8, 2011 The diagnosis of bipolar disorder may be missed in patients presenting with a major depressive episode, according to the results of a cross-sectional diagnostic study reported in the August issue of the Archives of General Psychiatry.
"Major depressive disorder, the most common psychiatric illness, is often chronic and a major cause of disability," write Jules Angst, MD, from the Division of Psychiatric Research, Zürich University Psychiatric Hospital in Zürich, Switzerland, and colleagues from the Bipolar Disorders: Improving Diagnosis, Guidance and Education (BRIDGE) Study Group. "Many patients with major depressive episodes who have an underlying but unrecognized bipolar disorder receive pharmacologic treatment with ineffective regimens that do not include mood stabilizers."
The goal of this study from the multicenter, multinational, transcultural BRIDGE initiative was to assess the frequency of bipolar disorder symptoms in patients presenting for treatment of major depressive episodes. The investigators identified 5635 adults seen at community and hospital psychiatry departments for an ongoing major depressive episode. Criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) and previously described bipolarity specifier criteria were used to examine the prevalence of bipolar disorder. Logistic regression allowed determination of variables associated with bipolarity, with significant associations defined as an odds ratio greater than 2 and P < .001.
DSM-IV-TR criteria for bipolar disorder were met by 903 patients (16.0%; 95% confidence interval [CI], 15.1% - 17.0%), and bipolarity specifier criteria were met by 2647 patients (47.0%; 95% CI, 45.7% - 48.3%). When both sets of criteria were applied, there were significant associations with bipolarity for a family history of mania or hypomania and multiple past mood episodes. When only the bipolarity specifier was used, there were also significant associations for manic/hypomanic states during treatment with antidepressant drugs, current mixed mood symptoms, and comorbid substance use disorder.
"The bipolar-specifier criteria in comparison with DSM-IV-TR criteria were valid and identified an additional 31% of patients with major depressive episodes who scored positive on the bipolarity criteria," the study authors write. "Family history, illness course, and clinical status, in addition to DSM-IV-TR criteria, may provide useful information for physicians when assessing evidence of bipolarity in patients with major depressive episodes. Such an assessment is recommended before deciding on treatment."
Limitations of this study include lack of random selection of participating centers, widely varying rates of hospitalized patients across countries, retrospective assessment of hypomanic symptoms, cross-sectional design, and lack of a healthy control group.
"[W]e recommend that, among patients with MDEs [major depressive episodes], the presence of bipolar features, including all those with significant predictive value reported in this study, should be investigated carefully before a decision is made to prescribe antidepressants," the study authors conclude. "If patients exhibit bipolar symptoms that impair everyday functioning, treatment with a mood stabilizer or an atypical antipsychotic may be useful. Treatment approaches for MDD [major depressive disorder] and bipolar disorder differ substantially."
sanofi-aventis supported this study and paid per-patient fees to all investigators who recruited patients.
Arch Gen Psychiatry.
Posted by Dinah on August 8, 2011, at 20:58:46
In reply to Underlying Bipolar May be missed In Depression, posted by Phillipa on August 8, 2011, at 20:45:16
That's what happened to me. The pdoc from h*ll kept raising my SSRI and adding drugs that worked on NE, I kept getting worse and symptoms kept popping up. I left him and went to the most well known psychiatrist in the area, who was following the same path.
By that time I was a wreck and only saw him for one or two sessions. My *new* new pdoc (now my former pdoc because of Katrina) put me on Depakote after our first session and I instantly improved. When I tapered off the SSRI's, I didn't really need much mood stabilizer at all.
The treatment is not only different, but the treatment for depression not on the bipolar spectrum is actually harmful to those on the bipolar spectrum.
Doctors should be more careful. I came closer to suicide than I had ever come before on Wellbutrin. Pdoc from h*ll's response? Raise the Wellbutrin dose.
Posted by morgan miller on August 8, 2011, at 21:34:02
In reply to Underlying Bipolar May be missed In Depression, posted by Phillipa on August 8, 2011, at 20:45:16
It happened to me, but I was seen as anxious, depressive, and ocd. You would have thought with the long lapses in employment and some of my behaviors some of the mental health professionals I saw would have had a clue, well, they didn't.
Posted by Phillipa on August 8, 2011, at 21:52:55
In reply to Re: Underlying Bipolar May be missed In Depression, posted by morgan miller on August 8, 2011, at 21:34:02
So did you both develop manic symptoms on ad's? As been on them for years even tried trileptal and lamictal but the benzos are really the only things that helped. No longer tolerant. Phillipa
Posted by morgan miller on August 8, 2011, at 23:53:46
In reply to Re: Underlying Bipolar May be missed In Depression, posted by Phillipa on August 8, 2011, at 21:52:55
I had manic symptoms on and off antidepressants. Antidepressants were not what revealed underlying bipolar. Antidepressants just seemed to put me in a more consistent, more controlled, more at ease, more stable, and feel good state of mania, sort of hypomanic.
Posted by Meddy43 on August 9, 2011, at 0:33:03
In reply to Re: Underlying Bipolar May be missed In Depression, posted by morgan miller on August 8, 2011, at 23:53:46
I agree on the screening and questioning !
I could have been spared of 25 years of intermittent heck if I hadn't been given SSRI's and pushed me into mixed states and psychosis.
Well, I'm happy I sought the opinion of 5 of my countrys most prominent psychiatrist when hypomanic for a diagnostic evaluation 6 years ago.
Finally I felt like someone thought I actually had a treatable illness !
Kindly, Meddy43
Posted by Phillipa on August 9, 2011, at 19:53:37
In reply to Re: Underlying Bipolar May be missed In Depression, posted by Meddy43 on August 9, 2011, at 0:33:03
So basically you both did show signs of bipolar illness? Prior. Phillipa
Posted by sheilac on August 12, 2011, at 16:24:54
In reply to Re: Underlying Bipolar May be missed In Depression » Meddy43, posted by Phillipa on August 9, 2011, at 19:53:37
I totally showed signs of being bipolar since a very young age. It really came out in my teens. Because my lows were so bad, I was given SSRIs to take care of the depression, which over many years really brought my bipolar to the forefront. The various antidepressants made me hyper and hypomanic at times. People just thought I had a really great personality!
Then a doc thought I was too happy to be depressed and I must have ADD. That was another disaster!
Finally, in recent years I KNOW that I cannot tolerate antidepressants because they bring out my bipolar illness. I am much more stable on a constant level of mood stabilizer (for me it's Geodon for now) and Klonopin.
But back in the late 80's and early 90's docs were passing out antidepressants like candy (even got some from my OB/GYN!) and weren't doing a good job of screening. Even though I always told my docs that my father was super bipolar and committed suicide! But maybe back then they didn't know as much as they do now. Or the kick backs from the drug reps were too good!
I know my body much better now than ever and know what makes me nuts and what doesn't. Antidepressants make me nuts. That simple.
Posted by floatingbridge on August 14, 2011, at 15:55:09
In reply to Re: Underlying Bipolar May be missed In Depression, posted by sheilac on August 12, 2011, at 16:24:54
Snri's made me worse. An add-on of strattera started a cascade of pain and physical symptoms that have not fully abated, but have improved since stopping the selectives. Raynaud's is improved. That started with Strattera. Carpal tunnel (!) has completely remitted. That presented on Cymbalta.
I am not sure if I could make it with out an antidepressant. Hence Emsam and hoping to avoid the selectivity nightmare. I don't know if mao inhibitors have that advantage over their late born relatives. But I hadn't realized how the ssri/snri's agitated me and fed these daily micro-cycles until I withdrew. Then I realized, heck, I'm still depressed, but it was like the
moment Dorthy's house hits down in Oz. Very quiet and still.
Posted by Phillipa on August 14, 2011, at 20:42:48
In reply to Re: Underlying Bipolar May be missed In Depression, posted by floatingbridge on August 14, 2011, at 15:55:09
Renauds? Hasimotos? that's two autoimmune diseases. Have you google all the names of them. Could be that you have one that is causing depression. And a med for that particular illness is the answer. I know a wild thought. Love Phillipa
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