Depression Preceding Diagnosis of Bipolar Disorder
| Autor: | Claire O'Donovan, Martin Alda |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
lcsh:RC435-571 adverse response to antidepressants mixed depression early onset Review Adult age Pharmacological treatment 03 medical and health sciences 0302 clinical medicine lcsh:Psychiatry mental disorders Medicine Bipolar disorder Family history Psychiatry Depression (differential diagnoses) Early onset bipolar disorder business.industry staging medicine.disease 030227 psychiatry Psychiatry and Mental health mood stabilizers Hypomania family history (FH) polarity at onset medicine.symptom business Mania 030217 neurology & neurosurgery |
| Zdroj: | Frontiers in Psychiatry Frontiers in Psychiatry, Vol 11 (2020) |
| ISSN: | 1664-0640 |
| Popis: | This paper focuses on depression that precedes an onset of manifest bipolar disorder as early stage bipolar disorder. First, we review how to pragmatically identify the clinical characteristics of patients presenting with an episode of depression who subsequently go on to develop episodes of mania or hypomania. The existing literature shows a strong consensus: accurate identification of depression with early onset and recurrent course with multiple episodes, subthreshold hypomanic and/or mixed symptoms, and family history of bipolar disorder or completed suicide have been shown by multiple authors as signs pointing to bipolar diagnosis. This contrasts with relatively limited information available to guide management of such "pre-bipolar" (pre-declared bipolar) patients, especially those in the adult age range. Default assumption of unipolar depression at this stage carries significant risk. Antidepressants are still the most common pharmacological treatment used, but clinicians need to be aware of their potential harm. In some patients with unrecognized bipolar depression, antidepressants can not only produce switch to (hypo)mania, but also mixed symptoms, or worsening of depression with an increased risk of suicide. We review pragmatic management strategies in the literature beyond clinical guidelines that can be considered for this at-risk group encompassing the more recent child and adolescent literature. In the future, genetic research could make the early identification of bipolar depression easier by generating informative markers and polygenic risk scores. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
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