Bipolar disorder affects approximately 2% of U.S. adults and is the most expensive mental health condition for commercial insurers nationwide. Rates of bipolar disorder are elevated among persons with depression, anxiety disorders, and substance use disorders—conditions frequently seen by primary care clinicians. In addition, antidepressants can precipitate manic or hypomanic symptoms or rapid cycling in persons with undiagnosed bipolar disorder. Thus, screening for bipolar disorder in these high-risk groups is indicated. Effective treatments exist for hypomania and mania, bipolar depression, and maintenance. Many such treatments can be safely and effectively administered by primary care clinicians.
Use this to:
- Review the diagnostic criteria for bipolar depression.
- Review the first-line therapy for bipolar depression.
- What are the implications of bipolar depression in patients with common chronic medical conditions, such as diabetes, hypertension, substance use disorder, HIV infection, and cardiovascular disease?
- Do you think that internal medicine physicians can and should manage bipolar depression or if all patients with this condition should be referred to psychiatrists?