JAMA Logo Distinguishing between major depressive disorder and bipolar disorder seems to be an uphill task for clinicians. Novel investigations can probably help identify individuals at risk for bipolar disorder. A latest study claims that presence of a psychotic symptom among patients with major depression need not signal underlying bipolar disorder or presage resistance to treatment with antidepressants.

The study was commenced on 4,041 adults diagnosed with depression and treated by the antidepressant citalopram. Participants were followed by up to three next-step treatments as needed depending on their response. In the initial stages of the investigation, patients were asked about psychotic symptoms and beliefs about being controlled, having special powers or being plotted against. 1,198 patients forming 30 percent probably had one such symptom in the previous six months. Subjects with such symptoms may be less likely to go into remission over all the treatment periods.

Experts quote, “Considered as a whole, our results cast doubt on the frequent assertion that unrecognized bipolar disorder is widespread in clinical practice and particularly in treatment-resistant major depressive disorder. Screening for bipolar disorder among psychiatric patients remains important, as does considering individual risk factors such as family history or age at onset. Still, our findings indicate that, in most individuals presenting with a major depressive episode without a prior manic or hypomanic episode, unrecognized bipolarity does not appear to be a major determinant of treatment resistance.”

Authors also questioned patients about other characteristic features of bipolar disorder. A total of 1,524 patients representing 38.1 percent reported at least one manic-like symptom. Among these signs irritability seems to be correlated with poor treatment outcomes. Roy H. Perlis, M.D., M.Sc., of Massachusetts General Hospital and Harvard Medical School, Boston, and colleagues noted that various indicators consistently associated with bipolar disposition in the literature. The history of manic symptoms and family history of bipolar disorder were supposedly not linked with outcome of treatment with antidepressants. Briefer episode duration asserts that a risk marker for bipolarity is related to greater likelihood of remission.

The study will be published online in the April 2011 print issue of Archives of General Psychiatry, one of the JAMA/Archives journals.