Study Identifies Predictors Of Bipolar Disorder Risk

A new study presented today at the
159th Annual Scientific Meeting of the American Psychiatric Association
(APA) in Toronto, Canada identified five predictors for bipolar disorder
risk in patients who have been unsuccessfully treated with antidepressants.
Researchers concluded that significant risk factors of bipolar disorder
among patients already diagnosed with major depression were anxiety,
feelings of people being unfriendly, family history of bipolar disorder, a
recent diagnosis of depression, and legal problems.


The study also found that forty-three percent of patients who responded
positively to any three risk factors, screened positive for bipolar
disorder using the Mood Disorder Questionnaire (MDQ), a validated screener
for bipolar disorder. In addition, one-third of patients whose medication
for their depression was not right for them and that they had been told by
a doctor they had anxiety and felt people were unfriendly toward them,
screened positive for bipolar disorder, using the MDQ.


Based on these findings, a brief assessment tool was derived that can
be used to identify bipolar disorder risk.


"Bipolar depression may be difficult for both patients and doctors to
identify because the symptoms are often confused with major depression,"
said Joseph R. Calabrese, M.D., Professor of Psychiatry, Case Western
Reserve University and Director, Mood Disorders Program, University
Hospitals of Cleveland. "Given the difficulty of diagnosing bipolar
disorder, the five predictors identified in this study may help physicians
better assess a patient's risk for bipolar disorder, which could lead to
more effective treatment."


The study findings coincide with previous research that suggests nearly
half of all patients who have bipolar disorder will first be diagnosed with
major depression. Inappropriate treatment due to misdiagnosis can have a
harmful effect on patients potentially making the illness harder to treat;
antidepressants alone have been shown to induce mania or hypomania (a mild
form of mania) in some patients with bipolar depression. Furthermore,
people with untreated bipolar disorder can experience a greater frequency
of manic and depressive episodes, causing significant disruption in their
personal and professional lives.


"Many people with bipolar disorder face up to ten years of coping with
symptoms before getting an accurate diagnosis," said Karl Ackerman,
President of the Manic-Depressive and Depressive Association of Boston.
"For me, it was twelve years. Looking back, I realize the anxiety I
experienced along with my depression could have been another sign of
bipolar disorder. These predictors can be useful for patients who are
dealing with depression that isn't helped by medication."















"It's important for people who are suffering from depression to talk to
their doctors about other experiences and symptoms over their lifetime --
especially times when they were feeling really well," said Gary Sachs, MD,
Associate Professor of Psychiatry, Harvard Medical School and Director,
Bipolar Disorder Clinic and Research Program, Massachusetts General
Hospital. "Many patients with bipolar disorder go too long without a
correct diagnosis. This can mean years lost to an illness that can be
successfully managed when correctly diagnosed and treated. The predictors
identified in this study may help physicians and patients identify
depression associated with bipolar disorder rather than unipolar mood
disorder."


Study Design


The study was designed to identify predictors of bipolar disorder risk
among patients treated for major depression. Psychiatrists from community
and private practice clinic settings randomly selected patients who were
unsuccessfully treated with antidepressants. Patients self-reported
demographics, family history, co-morbid health status, alcohol/drug use,
legal problems, and current depression using the Centers for Epidemiologic
Studies Depression (CES-D) scale. Screening for bipolar disorder was
self-reported using the Mood Disorder Questionnaire (MDQ), a validated
screening instrument for Bipolar I and II disorders.


Of the 602 patients enrolled in the study, 18.6% screened positive for
bipolar disorder using the MDQ (MDQ+). Researchers identified five
significant variables associated with bipolar disorder risk: the CESD item
"people were unfriendly" (p