Do You Have Bipolar Disorder Instead of Depression?

At every depression visit, you and your doctor should monitor for symptoms of bipolar disorder, according to the 2010 American Psychiatric Association Depression Guidelines.

The bipolar disorders are mood disorders in which the patient experience episodes of elevated moods (feeling up or high or sometimes irritable) in addition to episodes of depression. The treatment of bipolar disorders (bipolar I and bipolar II) is different from the treatment of unipolar depression (the kind that these posts are about).

However, it is important to remember that unipolar depression is much more common than the bipolar disorders. “The vast majority of people treated for depression suffer from unipolar depression and this is reflected in the evidence available.” See the 2005 Scottish Bipolar Affective Disorder guidelines. The guideline is also an excellent resource for learning more about the diagnosis and treatment of bipolar disorders.

The Mood Disorders Questionnaire (MDQ) is a good instrument for this evaluation and is recommended by the guideline as well as by The Standards for Bipolar Excellence Program which produced the STABLE Resource Toolkit for bipolar management. The MDQ version included here has an excellent discussion of what the test really means.

Here’s a PDF copy of the MDQ that you can print and fill out.

There are instructions on how to score to your MDQ answers  and also what the what your score means. A positive score doesn’t mean that you have bipolar disorder instead of depression, rather it means that you and your doctor should look further. The STABLE toolkit recommends following up the a positive MDQ with the CIDI-based Bipolar Disorder Screening Scale. This is a series of questions that your doctor or another clinician will ask you. Detailed information on adminstration and interpretation of the instrument instrument are in the STABLE Resource Toolkit PDF on pages 16 – 20.

The CIDI-based Bipolar Disorder Screening Scale is derived from the World Health Organization’s Composite International Diagnostic Interview (CIDI), a structured psychiatric interview available online. All the current modules are available at the CIDI 3.0 Paper and Pencil Instrument (PAPI V7.1). The CIDI is currently being revised to reflect the newer coding and diagnostic guidelines.


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