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Delays of up to 10 years in diagnosing bipolar disorder

New evidence suggests that many people diagnosed with depression may actually live with bipolar disorder, a misdiagnosis that can be a major problem.

Image: Swamibu via Flickr/Creative Commons

THERE IS AN average delay of five to 10 years between the onset of bipolar disorder and its diagnosis, according to research published in The Lancet today.

Misdiagnosis of bipolar as unipolar depression is thought to occur in many patients who seek treatment for depression.

Depressive symptoms are considerably more prevalent than manic symptoms over the course of the illness for most people so they are more likely to seek treatment for them.

This misdiagnosis can cause major problems because medication used to treat depression is not the same as that used in the treatment of bipolar disorder. According to researchers, drugs for depression could even exacerbate the manic symptoms seen in bipolar.

One of the paper’s authors, Professor Mary Phillips, said, “Identifying objective biomarkers that differ between bipolar and unipolar depression would not only lead to more accurate diagnosis but potentially to new, personalised treatments, yet very little research has been undertaken in this area.

For instance, very few neuroimaging studies have been done in which the brains of people with bipolar disorder have been compared to those of people with unipolar disorder, and further research into this area is urgently needed.

Bipolar disorder is currently diagnosed on the basis of clinical symptoms, typically presenting as alternating periods of depression and mania. The episodes may be accompanied by other symptoms such as hallucination and delusions.

Evidence from a second paper published in The Lancet today suggests that genes can affect predisposition to the disorder.

Although the contribution of environmental and social factors towards a person’s risk of developing bipolar should not be underestimated, scientists’ growing knowledge of the importance of genetics may see the identification of the biological systems that lead to the illness. In turn, this could improve both the diagnosis and treatment of the disorder.

Bipolar disorder in its most pronounced forms – where patients experience recurrent episodes of mood disturbance – is thought to affect about 2 per cent of the world’s population. Milder forms impact the lives of another 2 per cent.

“Bipolar disorder is not just about the extremes of emotion: it is also about the individual who exists both at, and between, those extremes,” reads the editorial accompanying the Lancet series.

“The psychiatrist of the future must be able to ally human and scientific understanding; to collaborate meaningfully and respectfully with patients in planning care; and to be confident and pragmatic, but receptive to new discoveries that may challenge the very basis of his or her understanding of mental illness. Psychiatry demands exceptional doctors.”

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