Undiagnosed Bipolar Disorder — Common and Concerning

Study Summary

Many patients with major depressive episodes (MDEs) who have an underlying but unrecognized bipolar disorder receive pharmacologic treatment with ineffective regimens that do not include mood stabilizers. The objective of this multicenter, multinational, transcultural, cross-sectional, diagnostic study was to quantify how often bipolar disorder symptoms are encountered in patients seeking treatment for an MDE. Included were 5635 adults seen for an MDE at community and hospital psychiatry departments. A total of 903 patients fulfilled DSM-IV-TR criteria for bipolar disorder (16.0%; 95% confidence interval, 15.1%-17.0%), whereas 2647 (47.0%; 95% confidence interval, 45.7%-48.3%) met an alternate set of criteria for bipolarity called the “bipolarity specifier” criteria.


The authors provide supporting evidence that the bipolar-specifier criteria in comparison with DSM-IV-TR criteria were valid and identified an additional 31% of patients with MDEs who are better characterized as having bipolar rather than unipolar depression. This has substantial implications in terms of appropriate treatment selection because antidepressant monotherapy would be suboptimal for patients with bipolar depression. If we depend on DSM-IV-TR, this would come up in 1 of 6 patients presenting with an MDE. If we consider the “bipolarity-specifier” criteria, this diagnostic-therapeutic issue would be relevant in almost 1 of every 2 patients presenting for treatment with an MDE.

By Leslie Citrome, MD, MPH



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