Bipolar disorder in primary care: the bipolar spectrum is larger than was once believed, and misdiagnosis can lead to an unfavorable treatment response

Journal of Family Practice, March, 2003 by J. Sloan Manning

The potential for adverse treatment outcomes is high when bipolar patients present as depressed or anxious, are misdiagnosed as having unipolar depression, and receive unfocused therapies (particularly repeated trials of antidepressant monotherapies). Patients with histories of multiple antidepressant failures; erratic, exaggerated antidepressant responses; and antidepressant-related hypomania/mania or activation/agitation are all too common in primary care.

On the other hand, most patients with bipolar illness present initially in the primary care setting. Therefore, primary care clinicians are in a prime position to offer the potential benefits of early diagnosis and appropriate intervention with mood stabilizers Patients will benefit from either early triage to a psychiatrist or other mental health specialist or focused drug interventions in primary care.

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