Bipolar Depression

The use of antidepressants to treat depression among bipolar patients has remained a
controversial subject in the field of psychopharmacology. Research on appropriate treatment for
bipolar depression has been minimal compared to that of unipolar depression. The lack of
research and the controversy on how to treat the condition has made it even more complicated
for professionals as well as patients dealing with bipolar depression. In an article, Cheniaux and
Nardi (2019) explore the different ways in which bipolar depression is treated and what has been
approved. The Food and Drug Administration (FDA) has approved only four therapeutic
techniques for patients with bipolar depression. This is in contrast to twelve drugs that have been
approved to treat bipolar mania. Type II bipolar depression has attracted fewer researchers
compared to type I bipolar depression, and this could be the cause of the controversy on whether
or not to treat bipolar depression using antidepressants.
In the article, the authors explore diverse attitudes and concerns regarding the use of
antidepressants on patients with bipolar depression. Some scholars believe that substances
contained in antidepressants could be harmful to patients with bipolar depression, consequently
increasing their risk of self-harm and even suicide (Cheniaux & Nardi, 2019). The drugs are said
to induce rapid cycling and/or cause mania switches. Despite these views, physicians dealing
with bipolar depression patients use antidepressants more often than even what is advocated for
or what is allowed in the guidelines. Besides, antidepressants still remain the standard
medication prescribed for patients with bipolar depression.
The authors explore some of the questions of clinical studies that have been conducted on
the use of antidepressants to treat depression among bipolar patients. Some of these questions

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touch on the safety of antidepressants on bipolar patients and their effectiveness on unipolar
depression patients. They also explore the extent to which antidepressants are safe or tolerated in
the body of a bipolar patient, as well as whether safety varies depending on the class of
antidepressants.
The authors find that scholars do not reach a consensus on the safety or lack of it on the
use of antidepressants among bipolar patients. Some scholars hold that antidepressants are safer
for use among patients with type II bipolar depression as opposed to those with type I bipolar
depression (Cheniaux & Nardi, 2019). They, however, agree with Gitlin’s position on the fact
that the controversy is not on whether or not it is correct to use antidepressants but rather on the
variety of patients that the drugs would benefit.
The research recommends potential lines for future research on the specific patients that
are potentially harmed by antidepressants. Patients with bipolar depression are very
heterogeneous. Each has a mix of characteristics that may differ from the other, and this would
imply that antidepressants would not work the same in different patients. The line of research
that I would like to explore is on whether a depressed patient with “very little bipolar” would be
affected the same as one with extreme levels of bipolarity. What must a physician consider
before making a decision to administer or not to administer antidepressants to a patient with
bipolar depression? This is the line of research that I would like to explore because there lacks
clarity and certainty on what exactly should be done.
Another research conducted by McIntyre and Calabrese (2019) explores the challenges
faced by patients with bipolar depression. The authors found that bipolar depression is associated
with many challenges such as a high risk of suicide, burden of illness, high morbidity as well as
mortality. It, therefore, places a huge burden on the patient. Bipolar depression is a contributor to

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long-term dysfunction due to high rates of substance abuse, reduced work productivity, and
psychosocial impairment. Psychiatric comorbidities such as eating disorders and anxiety
disorders and medical comorbidities such as hypertension and obesity are common. The authors
acknowledge that currently, FDA has approved only three treatments for bipolar depression.
Remarkably, monotherapy is not recommended as a treatment option for these patients.
Evidently, there exists a high number of differential diagnoses and comorbid conditions
associated with bipolar disorder. This is even more complicated for bipolar depression, which
has an even higher differential diagnosis. Healthcare professionals thus face challenges in
making a correct diagnosis for bipolar depression. In a survey on patients with bipolar
depression, 69% of them reported that psychiatrists had misdiagnosed them (McIntyre &
Calabrese, 2019). Some visited a minimum of four psychiatrists before they could get an
accurate diagnosis. Only 20% of the patients in the survey stated that they received a correct
diagnosis during the first visit to a psychiatrist. The mean delay between the onset of bipolar
depression and an accurate diagnosis is five to ten years. Given the progressive nature of bipolar
depression, a correct and timely diagnosis is important, and clinicians should be attentive to pick
symptoms that are suggestive of this disorder.
There are adverse consequences linked to a misdiagnosis for bipolar depression. Some of
these are linked to inappropriate use of antidepressants and delay of proper treatment. There is
also an increased risk of switching from depression to hypomania or mania (McIntyre &
Calabrese, 2019). Therefore, bipolar depression is commonly misdiagnosed, and this calls for
vigilance among care providers. One of the ways is by critically evaluating the symptoms to
improve the accuracy of the diagnosis.

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The researchers also recommend a line of research to be explored in the future. First, they
suggest that researchers look into differential diagnoses for bipolar depression. These should be
critically analyzed whether a patient has low levels of bipolar or extreme levels of bipolar.
Primary care practitioners should be o the lookout for symptoms that specifically point to bipolar
depression and be able to provide a differential diagnosis. Also, an accurate diagnosis ensures
that proper treatment is provided and avoids unnecessary treatment using onotherapy
antidepressants. Bipolar depression has been proven to have a high burden of illness, and this is
increased by a prolonged period of unwellness.
Another line of research that can be explored based on these findings is on reducing the
burden of illness by increasing the accuracy of diagnosis. This can be made possible through
educating primary care providers on how t pick early signs associated with bipolar depression. It
can be made possible by providing seminars and workshops that focus on accurately diagnosing
bipolar depression to allow for timely treatment and reduced disease burden. Overall, I would
conduct research pursuing the effectiveness of training primary care providers and psychiatrists
on proper diagnosis in reducing the burden on patients with bipolar depression.

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References

Cheniaux, E., & Nardi, A. E. (2019). Evaluating the efficacy and safety of antidepressants in
patients with bipolar disorder. Expert Opinion on Drug Safety, 18(10), 893-913.
McIntyre, R. S., & Calabrese, J. R. (2019). Bipolar depression: the clinical characteristics and
unmet needs of a complex disorder. Current medical research and opinion, 35(11), 1993-
2005.