The impact of unrecognized bipolar disorders among patients treated for depression with antidepressants in the fee-for-services California Medicaid (Medi-Cal) program: A 6-year retrospective analysis

McCombs, Jeffrey S.; Ahn, Jeonghoon; Tencer, Thomas; Shi, Lizheng

doi:10.1016/j.jad.2006.06.018

Cited by 46 publications

(23 citation statements)

References 12 publications

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“…In addition to morbidity, the failure to diagnose bipolar disorder appears to incur significant additional costs (McCombs, et al, 2007). Any patient who is being treated for depression should be asked if they have a personal Evidence-based guidelines for treating bipolar disorder 359 history of abnormal mood elevation of any duration or a family history of affective disorder (D).…”

Section: Evidence-based Guidelines For Treating Bipolar Disorder 357mentioning

confidence: 99%

Evidence-based guidelines for treating bipolar disorder: revised second edition—recommendations from the British Association for Psychopharmacology

2009

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The British Association for Psychopharmacology guidelines specify the scope and target of treatment for bipolar disorder. The second version, like the first, is based explicitly on the available evidence and presented, like previous Clinical Practice guidelines, as recommendations to aid clinical decision making for practitioners: they may also serve as a source of information for patients and carers. The recommendations are presented together with a more detailed but selective qualitative review of the available evidence. A consensus meeting, involving experts in bipolar disorder and its treatment, reviewed key areas and considered the strength of evidence and clinical implications. The guidelines were drawn up after extensive feedback from participants and interested parties. The strength of supporting evidence was rated. The guidelines cover the diagnosis of bipolar disorder, clinical management, and strategies for the use of medicines in treatment of episodes, relapse prevention and stopping treatment.

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Section: Evidence-based Guidelines For Treating Bipolar Disorder 357mentioning

confidence: 99%

Evidence-based guidelines for treating bipolar disorder: revised second edition—recommendations from the British Association for Psychopharmacology

2009

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“…While recent attempts have failed in providing unequivocal support for the role of misdiagnosed bipolar disorder as a major cause for refractory depression [48], clinicians have nevertheless been urged to be more sensitive to “soft” bipolar signs when making a diagnosis, including “lowering the threshold” for hypomanic episodes [49]. A timely diagnosis of bipolar disorder has been shown to correlate with better outcomes [50–52] as well as reduced healthcare costs [53, 54], illustrating the importance of making a correct diagnosis as early as possible.…”

Section: Discussionmentioning

confidence: 99%

Antidepressant Treatment for Acute Bipolar Depression: An Update

Amit

Weizman

2012

Depression Research and Treatment

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While studies in the past have focused more on treatment of the manic phase of bipolar disorder (BD), recent findings demonstrate the depressive phase to be at least as debilitating. However, in contrast to unipolar depression, depression in bipolar patients exhibits a varying response to antidepressants, raising questions regarding their efficacy and tolerability. Methods. We conducted a MEDLINE and Cochrane Collaboration Library search for papers published between 2005 and 2011 on the subject of antidepressant treatment of bipolar depression. Sixty-eight articles were included in the present review. Results. While a few studies did advocate the use of antidepressants, most well-controlled studies failed to show a robust effect of antidepressants in bipolar depression, regardless of antidepressant class or bipolar subtype. There was no significant increase in the rate of manic/hypomanic switch, especially with concurrent use of mood stabilizers. Prescribing guidelines published in recent years rely more on atypical antipsychotics, especially quetiapine, as a first-line therapy. Conclusions. Antidepressants probably have no substantial role in acute bipolar depression. However, in light of conflicting results between studies, more well-designed trials are warranted.

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“…Shared diagnostic criteria and symptomatology (particularly with unipolar depression for adults, but also with schizophrenia), comorbidity with other disorders (e.g., substance abuse, anxiety disorders), the tendency for depressive episodes to precede episodes of mania or hypomania, poor diagnostic criteria for hypomanic episodes, lack of knowledge or awareness on the part of professionals, low rates of physician reimbursement for low-income health insured and/or not enough time spent with clients resulting in little inquiry about family history or hypomanic symptoms, lack of individual insight into symptoms and behaviors, and the tendency for individuals to seek help when depressed, but not manic, have all been presented as contributing to the current state of diagnosis (e.g., Benazzi, 2007 ;Emilien, Septien, Brisard, Corruble, & Bourin, 2007 ;McCombs, Ahn, Tencer, & Shi, 2007 ;Yen, Chen, Ko, Yen, & Huang, 2007 ).…”

Section: Challenges To a Bipolar Disorder Diagnosismentioning

confidence: 99%