A debate rages in the medical community on the prevalence of bipolar disorders and ADHD. According to some, the disorders are over-diagnosed and over-treated while others believe the conditions are understudied with the wrong type of medication(s) often prescribed potentially causing harm.
An essay in The Lancet, by an Italian researcher, Franco Benazzi (Hecker Psychiatry Research Center, Forli, Italy) reviews the concepts, definitions, and classifications of bipolar and related disorders, with a focus on bipolar II disorder and mixed depression.
Benazzi believes that despite a prevalence of about 5 percent in the community and 50 percent in depressed outpatients, the treatment of bipolar II disorder and related disorders warrant further investigation as current clinical care may be dangerous.
Bipolar II disorder is characterized by one or more major depressive episodes accompanied by at least one hypomanic episode.
The major difference between Bipolar I and Bipolar II is that Bipolar II has hypomanic but not manic episodes. Patients with bipolar I may have psychotic episodes, but hallucinations and delusions do not occur with bipolar II.
Bipolar disorder II is usually considered a less severe form of the disease.
Because mood swings are less obvious than with bipolar I, diagnosing bipolar disorder II remains a challenge. Patients often suffer from depression as well.
Benazzi believes this causes a problem as only the depression is treated, not the bipolar disorder.
Under-diagnosis of Bipolar II disorders can lead to pharmacological treatment with antidepressants alone, which can make the problem worse.
“These patients need to be on mood-stabilizing drugs, and if depression persists an antidepressant can be added,” Benazzi says.
“Treating these patients with antidepressants alone can actually increase the manic episodes and worsen the disorder.”
He notes that the apparent increase in prevalence of bipolar spectrum might be related to several changes in diagnostic criteria, including improved probing for history of hypomania, lower minimum duration of hypomania, and inclusion of unipolar depressions with bipolar signs such as family history of bipolar disorder and mixed depression.
He recommends caution in the treatment of mixed depression, for which some symptoms can be worsened by antidepressants and might be better controlled by initial treatment with mood stabilizers, although further evidence is needed.
Benazzi believes controlled pharmacological studies are greatly needed, with investigation over the broad spectrum of the disorders taking into account the frequently mixed profile of bipolar disorders.
Source: The Lancet