Diagnosing latent bipolar disorder: A clinical dilemma.

Within the bipolar world, there is a chronic gnashing of teeth among experts, decrying clinicians' poor ability to diagnose bipolar disorder early in the course of the disorder. The feared consequence of this delayed diagnosis is risking a greater number of episodes early in adult life and increasing the likelihood of prescriptions of antide-pressants without mood stabilizers with their attendant risks when taken by those diagnosed as having unipolar depression but who are latently bipolar. These papers typically point to the long time frame from initial depressive symptoms to the proper bipolar diagnosis, usually measured in many years if not a decade or more. Clinicians are then usually urged to be more vigilant in ferreting out subtle hypomanic symptoms and looking for predictors of bipolar outcome. The treatment implication of making this earlier, accurate diagnosis of bipolar disorder would be to institute mood stabilizers and (presumably) to avoid antidepressants. Of course, in order to follow these recommendations, predictors of bipolar outcome among depressed patients must be established and validated across studies. [ABSTRACT FROM AUTHOR]