Challenges in Bipolar Disorder: Discussion With Manish Zinzuvadia, MD

Manish Zinzuvadia, MD, sat down with Psychiatric Times at the Southern Florida Psychiatry Conference to discuss his presentation on bipolar disorder. Zinzuvadia emphasized the persistent challenges in accurately diagnosing bipolar disorder, particularly the prolonged diagnostic delay that often spans a decade.¹ He noted that early-onset presentations and initial depressive symptoms frequently lead clinicians toward conventional antidepressant therapy, which is typically ineffective and may obscure the underlying bipolar spectrum. Zinzuvadia stressed that diagnostic clarity remains central to effective treatment, as pharmacologic decisions hinge on properly identifying the disorder.

A major contributor to missed or delayed diagnosis, he explained, is underreporting of manic or hypomanic symptoms. Patients may minimize or fail to recognize prior episodes, requiring clinicians to gather collateral information from family members or review past hospitalizations and functional impairments. He underscored the utility of structured screening tools to guide initial assessment and improve diagnostic accuracy, particularly given the absence of reliable biomarkers. Thorough clinical history like medication trials, treatment responses, and external observations remains the foundation of diagnosis.

Regarding treatment, Zinzuvadia highlighted the complexity of bipolar depression, noting its limited therapeutic options compared with mania. Familiarity with available agents and appropriate dosing strategies is essential, as patients are more likely to seek care during depressive episodes. He encouraged clinicians to broaden their knowledge of emerging modalities, such as neuromodulation and collaborative care models, which vary widely by region and practice setting.²

Zinzuvadia emphasized the importance of professional networking and multidisciplinary dialogue. Engaging with colleagues across diverse clinical environments, he stated, expands understanding of therapeutic possibilities and supports continuous improvement in the management of bipolar disorder.

Dr Zinzuvadia is a practicing psychiatrist in New York, treating mood disorders, anxiety disorders, and more.

References

1. Hoppe, Watson S, Ahuja N, et al. Reducing the delay in the diagnosis of bipolar disorder: A Qualitative Study. Health Expect. 2025;28(4):e70398.

2. Levenberg K, Cordner ZA. Bipolar depression: a review of treatment options. Gen Psychiatr. 2022;35(4):e100760.