Depressive Symptoms – Could it be Bipolar Depression? An Overview for Primary Care

Depression is often the initial and predominant disease presentation in patients with bipolar disorder leading to their frequent misdiagnosis with major depressive disorder. Primary care clinicians (PCCs) are often the first and only healthcare providers for patients with mental health issues, so knowledge to facilitate earlier recognition, more accurate diagnosis, and management of bipolar disorder is essential. A multistep literature search was conducted to summarize the current situation of diagnosis and management of patients with bipolar disorder. 25% of patients presenting with depression symptoms in primary care have bipolar disorder. Only 20% of patients with a bipolar depression episode are correctly diagnosed within one year of seeking treatment; mean delay is 5-10 years. Improper MDD diagnosis occurs in 60% of cases. PCCs should be aware of factors associated with bipolar disorder. Screening tools to identify these factors and depressive aspects of bipolar disorder, such as the 6-item Rapid Mood Screener, are helpful. Missed or inaccurate diagnosis can worsen outcomes, increase suicide risk, and lead to improper treatment with antidepressant monotherapy, which lacks proven efficacy and may be hazardous. There are four FDA-approved agents for bipolar depression, but only cariprazine and quetiapine are also approved for manic/mixed episodes, covering the bipolar spectrum. PCCs are the primary mental health care network. Bipolar disorder is frequently misdiagnosed, particularly as MDD, leading to improper treatment with antidepressant monotherapy. Enhanced rapid tools for screening of bipolar disorder, such as the Rapid Mood Screener, are crucial for PCCs to effectively treat bipolar disorder.