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Contrary to popular belief bipolar (manic depression) was an uncommon disorder. It was found in 1% of the population in the developed world. It was also an episodic illness. Between episodes most people led normal and productive lives. This differentiated it from schizophrenia. There are several factors that may be involved in its remarkable increase and the chronicity associated with it today. Firstly, the loosening of diagnostic parameters, where even brief mood changes (lability) during a day can attract a bipolar diagnosis, has led to increasing numbers of trial and error drug regimes being used, exposing people to seriously questionable, and at times dangerous drug programs.
Secondly, there is evidence that the drugs are producing effects that mimic bipolar symptoms, which are then treated as primary symptoms and medicated even further. Thirdly, a well known psychological effect, "seek and ye shall find" is operating across the medical profession today, possibly associated with fears of litigation, loss of credibility etc. Fourthly, primary pressure from advertising and drug company reps, and secondarily from patients responding to advertising of psychotropic drugs, is known to increase both diagnosis and prescribing. Essentially bipolar disorder is POPULAR which means the pressure to find it is increased.
Sadly the medicalisation of normal behaviour is now reaching ridiculous proportions. When the director of the largest mental...
Competing Interests: None declared. - Page navigation anchor for Re: Unrecognised bipolar disorder among UK primary care patients prescribed antidepressants: an observational study: where to from here?Re: Unrecognised bipolar disorder among UK primary care patients prescribed antidepressants: an observational study: where to from here?
We write from the perspectives of a GP and two psychiatrists with longstanding interests in bipolar disorder (‘BD’).
Tom Hughes and colleagues’ important paper highlights one of the many diagnostic challenges of primary care. But this is also system-wide issue as BD is overlooked in secondary care too.1
There are serious implications if BD is misdiagnosed in either direction. Common differentials (often comorbid) include premenstrual dysphoric disorder, emotionally unstable/borderline personality traits/disorders and substance misuse. And whilst people with BD predominantly suffer anxiety/depression2 most people with anxiety/depression seen in Primary care do not have BD. Furthermore, those who really do may not recognise their hypo/mania. Confirmation of the poor predictive value of the MDQ in Bipolar II is important, and whilst other questionnaires perform better, they are time consuming and do not replace expert assessment.
A suggested flowchart for GPs3 addresses some of these issues, but this remains difficult medicine.
Where to from here?
1. Given this complexity, diagnostic delays may always be inevitable to some degree. We should also be mindful of the implications of more referrals to already over-stretched 2ry care, and the opportunity costs (what should we stop doing in order to do this?)
2. Emphasis on the increase in activity a...
Show MoreCompeting Interests: Dr Dietch: I am an NHS GP Partner and earn part of my income from the NHS Quality and Outcome Framework (QOF). QOF includes targets for the management of depression and bipolar disorder. Dr Macritchie: no competing interests Professor Young: Employed by King’s College London; Honorary Consultant SLaM (NHS UK) Paid lectures and advisory boards for all major pharmaceutical companies with drugs used in affective and related disorders No share holdings in pharmaceutical companies Lead Investigator for Embolden Study (AZ), BCI Neuroplasticity study and Aripiprazole Mania Study Investigator initiated studies from AZ, Eli Lilly, Lundbeck, Wyeth Grant funding (past and present): NIMH (USA); CIHR (Canada); NARSAD (USA); Stanley Medical Research Institute (USA); MRC (UK); Wellcome Trust (UK); Royal College of Physicians (Edin); BMA (UK); UBC-VGH Foundation (Canada); WEDC (Canada); CCS Depression Research Fund (Canada); MSFHR (Canada); NIHR (UK).