A pilot study differentiating recurrent major depression from bipolar disorder cycling on the depressive pole

Abstract

PurposeA novel method for differentiating and treating bipolar disorder cycling on the depressive pole from patients who are suffering a major depressive episode is explored in this work. To confirm the diagnosis of type 1 or type 2 bipolar disorder, the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria require that at least one manic or hypomanic episode be identified. History of one or more manic or hypomanic episodes may be impossible to obtain, representing a potential blind spot in the DSM-IV diagnostic criteria. Many bipolar patients who cycle primarily on the depressive side for many years carry a misdiagnosis of recurrent major depression, leading to treatment with antidepressants that achieve little or no relief of symptoms. This article discusses a novel approach for diagnosing and treating patients with bipolar disorder cycling on the depressive pole versus patients with recurrent major depression.Patients and methodsPatients involved in this study were formally diagnosed with recurrent major depression under DSM-IV criteria and had no medical history of mania or hypomania to support the diagnosis of bipolar disorder. All patients had suffered multiple depression treatment failures in the past, when evaluated under DSM-IV guidelines, secondary to administration of antidepressant drugs and/or serotonin with dopamine amino acid precursors.ResultsThis study contained 1600 patients who were diagnosed with recurrent major depression under the DSM-IV criteria. All patients had no medical history of mania or hypomania. All patients experienced no relief of depression symptoms on level 3 amino acid dosing values of the amino acid precursor dosing protocol. Of 1600 patients studied, 117 (7.3%) nonresponder patients were identified who experienced no relief of depression symptoms when the serotonin and dopamine amino acid precursor dosing values were adjusted to establish urinary serotonin and urinary dopamine levels in the Phase III therapeutic ranges. All of the 117 nonresponders who achieved no relief of depression symptoms were continued on this amino acid dosing value, and a mood-stabilizing drug was started. At this point, complete relief of depression symptoms, under evaluation with DSM-IV criteria, was noted in 114 patients within 1–5 days. With further dose adjustment of the mood-stabilizing drug, the remaining three nonresponders achieved relief of depression symptoms.ConclusionResolution of depression symptoms with the addition of a mood-stabilizing drug in combination with proper levels of serotonin and dopamine amino acid precursors was the basis for a clinical diagnosis of bipolar disorder cycling on the depressive pole.

Relative nutritional deficiencies associated with centrally acting monoamines

“…Then, 1 week later, a urine sample is obtained, monoamine assays are performed, and MTO interpretation is done. This enables a proper decision on the modification of amino acid dosing values in order to achieve both the serotonin and dopamine in the optimal phase 3 ranges 3,4,6,12…”

“…The optimal phase 3 ranges of serotonin and dopamine are achieved with the benefit of MTO. This is a complex task because, in the competitive inhibition state, changing one amino acid precursor changes all components of the equation shown in Figure 2 3,4,6,12…”

“…The patient must be taking monoamine precursors in significantly varied doses for five or more days continuously to allow for equilibration of the system to the dosing change. The results of these serial assays are then compared to determine the change in urinary serotonin and dopamine levels in response to the change in amino acid precursor dosing values 3,4,6,12…”

To Be or Not to Be a Bipolar Disorder Patient

“…Many patients with BD who have had a preponderance of depressive symptoms for many years carry a misdiagnosis of recurrent major depression, leading to treatment with antidepressants that achieve little or no relief of symptoms (Hintz et al, 2010). To confirm the diagnosis of BD I or II, the DSM-IV criteria require that at least one manic or hypomanic episode be identified.…”

“…Frequently, the manic or hypomanic episode may have lasted only a short time, during which neither the patient nor others around him/ her ever appreciated its presence. Hintz et al (2010) have proposed that resolution of depressive symptoms with the addition of a moodstabilizing drug in combination with proper levels of serotonin and dopamine amino acid precursors could be the basis for a clinical diagnosis of BD cycling on the depressive pole. In a recent retrospective administrative claims-based analysis, it has been demonstrated that an incongruent diagnosis of unipolar depression in persons previously identified with BD seems to be relatively frequent and costly.…”