TY - JOUR T1 - Bipolar spectrum disorders in primary care: optimising diagnosis and treatment JF - British Journal of General Practice JO - Br J Gen Pract SP - 322 LP - 324 DO - 10.3399/bjgp10X484165 VL - 60 IS - 574 AU - Daniel J Smith AU - Ajay Thapar AU - Sharon Simpson Y1 - 2010/05/01 UR - http://bjgp.org/content/60/574/322.abstract N2 - Depression is an extremely common presentation in primary care and the public health importance of depressive disorders are now very well established.1,2 Patients with bipolar affective disorder (who experience episodes of depression alternating with episodes of mania or hypomania), frequently present to their GPs with difficult-to-treat depressive episodes. Indeed, for most of these patients, depressive symptoms (rather than manic symptoms) dominate the long-term clinical course of their illness.Bipolar disorder type I (BD-I; depression alternating with mania) affects around 1% of the population and bipolar disorder type II (BD-II; depression alternating with hypomania) affects a further 2–3%.3 Although the clinical features of BD-I and BD-II are widely known, it is less well recognised that the boundary between bipolar disorder and recurrent unipolar depression is far from clear-cut.4 A significant proportion of patients with unipolar depression experience mild or brief episodes of hypomania which fall below the threshold for a formal diagnosis of BD-I or BD-II.5–7 These ‘bipolar spectrum’ patients often have patterns of depressive episodes, comorbidities, and treatment responses that differ from those with more straightforward unipolar depression and which, therefore, require a different approach to diagnosis and management. This generally under-recognised issue has far-reaching implications for the way in which clinicians, particularly GPs, approach the assessment and management of all of their depressed patients.Within the research community, there is an emerging consensus that the diagnostic criteria for hypomania are overly restrictive and result in many patients with significant bipolar symptoms being placed within the broad diagnostic category of … ER -