Sally Miller, PhD: The Challenges of Bipolar Depression


Bipolar depression can be difficult to treat and is often misdiagnosed.

Bipolar depression is 1 of the most misunderstood and ultimately misdiagnosed mental health disorders out there. It often can be confused with other forms of depression, leading to primary care doctors diagnosing it as such.

In an interview with MD Magazine® during the 2nd Annual Advanced Practice Collaborative on September 7, Sally K. Miller, PhD, a clinical professor at the Drexel University College of Nursing and Health Professions, explained some of the reasons why diagnosing patients with bipolar depression is often a difficult task.

MD Mag: What are some of the challenges when addressing bipolar depression?

Miller: The biggest challenge of bipolar disorder and bipolar depression especially is recognizing it, is identifying it. It just often gets missed, especially in the primary care setting. We're so geared to screening for depression, we ask questions about depression and look for diagnostic criteria for depression and depression is just one pole of bipolar disorder.

The up pole, the up mood, the happy grandiosity ‘I can do anything,’ people don't complain about that. You know people don't complain about feeling good and getting a lot of things done and so if we don't ask the questions if we really don't go after it we don't know that they're bipolar we just think they're depressed.

The biggest challenge is actually making the right diagnosis. Once you know what's wrong with someone then we know how to treat it. It's getting the right diagnosis.

MD Mag: How often is bipolar depression misdiagnosed?

Miller: I don't have a statistic for you in the primary care setting, which is where it is typically misdiagnosed but I would guess conservatively at least 50% of the cases because as I say in when people come in with complaints it's depression. They're complaining about depression and primary care providers are conditioned to evaluate for depression and if the patient meets criteria for depression they treat them for depression. Bipolar is a very different disorder and they don't usually respond to antidepressants so I would say easily at least half the time they're misdiagnosed.

MD Mag: Are there any new treatments that have been particularly effective in treating bipolar depression?

Miller: So, the thing about bipolar depression is we treat it with mood stabilizers and antipsychotics and the challenge with those medications always is it's not that they don't work, they do work, it's just that the side effects are intolerable. People don't want to take them and so they stop taking them so really the trend in developing new medications is trying to find those that are effective but don't have such a profound side effect profile that people give it up. There are newer drugs on the horizon, it seems like all the time I'm hearing about new antipsychotics. So yes, they are coming.

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