The impact of bipolar depression.

Bipolar disorder is a chronic, intermittent illness that is associated with high morbidity and mortality. In addition, patients with bipolar disorder often have comorbid psychiatric conditions (such as anxiety disorders, alcohol or substance abuse, and eating disorders) or medical disorders (such as obesity), which result in increased burden of illness for the patients, family members, and treating clinicians. Although bipolar disorder consists of recurring episodes of mania and depression, patients spend more time depressed than manic. Bipolar depression is associated with a greater risk of suicide and of impairment in work, social, or family life than mania. This health burden also results in direct and indirect economic costs to the individual and society at large. Bipolar depression is often undiagnosed or misdiagnosed as unipolar depression, resulting in incorrect or inadequate treatment. Available treatments for bipolar depression include medications such as lithium, selected anticonvulsants, and the atypical antipsychotics. Traditional antidepressants are not recommended as monotherapy for bipolar depression as they can induce switching to mania. Early and accurate diagnosis, aggressive management, and earlier prophylactic treatment regimens are needed to overcome the impact of depressive episodes in patients with bipolar disorder.