BRIDGE Study Finds Bipolar Disorder Missed in Major Depression Diagnoses

October 6, 2011
Kenneth J. Bender, PharmD, MA

An initiative from the BRIDGE study group has determined that approximately half of patients presenting with a depressive episode are mistakenly diagnosed with unipolar major depression.

A multi-center, multi-continent international initiative from the BRIDGE (Bipolar Disorder: Improving Diagnosis, Guidance and Education) study group has determined that approximately half of patients presenting with a depressive episode are mistakenly diagnosed with unipolar major depression, instead of the bipolar disorder they subsequently evidence in more thorough workup.1

The investigators reported in the August Archives of General Psychiatry that further evaluation of these patients with DSM IV-TR criteria revealed 16.1% had bipolar disorder rather than unipolar depression; and application of previously developed and validated bipolarity specifier criteria that consider family history and illness course revealed that 47% of the patients should have been diagnosed with bipolar disorder.2

The investigators point out that this common misdiagnosis can not only result in patients with bipolar disorder not receiving necessary mood stabilizer treatment, but that they are likely to receive antidepressant treatment, “which may aggravate bipolar symptoms or trigger a manic or hypomanic episode.”

References

1. Bowden CL, Peugi G, Vieta E, et al. Prevalence and characteristics of undiagnosed bipolar disorders in patients with a major depressive episode: The BRIDGE study. Arch Gen Psychiatry. 2011;68:791-799.
2. Angst J, Gamma A, Benazzi F, et al. Diagnostic issues in bipolar disorder. Eur Neuropsychopharmacol. 2003;13(Suppl 2):S43-S50.