COMMENTARY

Bipolar Disorder: Improving Diagnosis and Treatment

Matt A. Goldenberg, DO

Disclosures

June 02, 2015

In This Article

Bipolar Disorder: Introduction

My previous article, "A Guide to Treating Depression," discussed the experience of seeing a psychiatrist for the first time. However, not every patient comes to my office for an initial evaluation with depression. Patients often need help with anxiety, obsessive thoughts, psychosis, problems with attention, trouble sleeping, or mood swings.

The initial appointment for each of these chief complaints is very similar. As a psychiatrist, I begin by prompting the patient to discuss what brought them in, and what we will be working on together. I then conduct a detailed patient interview history, asking the patient several questions to get me up to speed with regard to their history. In most cases, I will order necessary laboratory tests and collect any relevant collateral information from family and other previous doctors before establishing a diagnosis and treatment plan.

My training has taught me to evaluate for specific diagnostic criteria (nuances in the patient's story) to differentiate between many possible diagnoses. Many of these differential diagnoses present with seemingly similar symptoms to an untrained eye. A proper diagnosis is essential for developing a treatment plan that optimizes outcomes.

In my experience, one of the most difficult and critical diagnostic considerations is differentiating unipolar from bipolar depression in patients who present to the clinic with severe depression. What makes this most challenging is that patients with both bipolar disorder (bipolar depression) and major depressive disorder (unipolar depression) can present with depression that looks, feels, and appears to be identical.

Although most patients present to their primary care doctor with depression, the importance of making a correct diagnosis is why I believe that it is good practice to recommend a consultation from a psychiatrist. Psychiatrists are trained to make these distinctions and formulate a proper treatment plan.

There is a lot at stake in mistaking bipolar disorder for major depressive disorder; for example, it can lead to worsening symptoms, adverse outcomes, overmedication (or the wrong medication), and unnecessary hospitalization. Therefore, when a patient presents to my office with depression, I always rule out bipolar disorder.

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