Magazine article Clinical Psychiatry News
Suspect Bipolar Disorder? Try Mood Stabilizer First. (Use before Antidepressants)
ASPEN, COLO, -- Most psychiatrists today see nothing but complex cases of mental illness--a situation created, in part, by primary care physicians' suboptimal treatment of earlier, simpler episodes in the same patients, Dr. Steven L. Dubovsky said at a psychiatry conference sponsored by the University of Colorado.
"I haven't seen any simple psychiatric illness in about 20 years; these patients are all in the primary care doctors' offices. Psychiatrists and the other mental health professionals are seeing much more complicated patients. Some of these complications are caused by a low threshold to throw medicines that may not be the best treatment for those with unstable moods," said Dr. Dubovsky professor and vice chairman of psychiatry and professor of medicine at the Univ. of Colorado, Denver, and a national authority on mood disorders.
When there is any suspicion that a depressed patient may have a bipolar disorder, start with a mood-stabilizing agent. This is the first principle in the successful treatment of mood disorders, he said.
"It's generally safer if you think you may be dealing with bipolar symptoms, but aren't sure, to try the bipolar medication first because the worst that can happen is the patient will have side effects. Once you make a patient manic [as can happen by giving a bipolar depressed patient an antidepressant], you will permanently alter the course of their illness. This has been demonstrated both in adults and adolescents with bipolar disorder. After their first episode of mania, they experience more complex and refractory mood swings."
Because mood disorders evolve over time, early interventions are easier than later ones. After a first episode of unipolar depression, a patient has a 50% chance of experiencing a second episode. After four episodes, there's roughly a 95% chance of having a fifth. Each new episode has a more abrupt onset and more complex and treatment-resistant symptoms. Substance abuse as self-medication aggravates unipolar depression as well as bipolar disorder. …