Calabrese et al identified predictors associated with bipolar disorder in patients being treated for major depression. This can help identify a subset of patients who have a mood disorder that may be resistant to antidepressants. The authors are from Case Western Reserve University, Cleveland Clinic, Northwestern University, Massachusetts General Hospital and other universities and companies in the United States.
Patient selection: Patient being treated for major depression
Factors associated with bipolar disorder in these patients:
(1) comorbid anxiety
(2) initial depression diagnosis made within past 5 years
(3) family history of bipolar disorder
(4) legal problems
(5) positive response to CES-D item "people were unfriendly"
The presence of >= 3 of these factors was associated with evidence of bipolar disorder on the MDQ+ in a significant percentage of patients (41%).
Number of Factors
Risk of Bipolar Disorder
0
2%
1
10%
2
15%
3
43%
4
25%
5
100%
from Figure 1
The authors recommended that patients with the diagnosis of major depression should be screened for bipolar disorder, especially if the patient had failed 1 or more types of antidepressants.
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