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Bipolar II and the bipolar spectrum.

Peter Skeppar1, Rolf Adolfsson

  • 1Department of Adult Psychiatry, Sunderby Hospital, SE-971 80, Lule, Sweden. peter.skeppar@nll.se

Nordic Journal of Psychiatry
|February 28, 2006
PubMed
Summary

Many patients diagnosed with depression or anxiety actually have bipolar spectrum disorders (BP), often type II. Early diagnosis and mood stabilizers are crucial, as antidepressants can worsen BP symptoms.

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Area of Science:

  • Psychiatry
  • Clinical Psychology

Background:

  • Recent studies indicate a high prevalence of bipolar spectrum disorders (BP), particularly bipolar II, among patients presenting with depression and anxiety.
  • BP often remains undiagnosed due to its concealment by other psychiatric conditions such as recurrent depression, anxiety, and attention-deficit hyperactivity disorder.

Purpose of the Study:

  • To highlight the frequent misdiagnosis of bipolar spectrum disorders in patients seeking treatment for depression.
  • To emphasize the genetic links and long-term conversion patterns from unipolar depression to BP.
  • To underscore the risks associated with antidepressant use in BP patients and advocate for mood stabilizers.

Main Methods:

  • Review of studies from the last decade focusing on patients with depression and anxiety.
  • Analysis of diagnostic patterns and comorbidity in psychiatric consultations.
  • Longitudinal study observations tracking mood disorder progression over decades.

Main Results:

  • Approximately 50% of patients consulting for depression are found to have BP, predominantly bipolar II.
  • BP exhibits strong heritability, with relatives showing high rates of various psychiatric conditions.
  • Long-term studies reveal common conversion from recurrent unipolar depression to BP.

Conclusions:

  • Mood-stabilizing medications are strongly recommended for BP treatment over antidepressants, which can be ineffective and induce mood swings.
  • Antidepressant use in BP patients can exacerbate the condition, leading to antidepressant-associated chronic irritable dysphoria (ACID).
  • Accurate diagnosis of BP is critical for effective treatment and preventing adverse outcomes.

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