We are frequently consulted by patients with treatment resistant depression (TRD).Reference Fogelson and Leuchter1 Many of these patients have never met criteria for a manic episode so they are not diagnosed with bipolar disorder (BPD). Consequently, they have undergone trials of antidepressants with or without augmentation therapies without success.Reference Perlis, Uher and Ostacher2 Antidepressants have caused increased agitation and anxietyReference Perlis, Smoller, Fava, Rosenbaum, Nierenberg and Sachs3, Reference Perugi, Pacchiarotti and Mainardi4 or have been ineffective. We believe that many of these patients would receive effective treatment if they were reconceptualized to be suffering from bipolar spectrum disorder (BPSD) and treated for bipolar depression. The diagnosis of major depressive disorder (MDD) with mixed featuresReference Koukopoulos and Sani5, Reference Suppes and Ostacher6 is not the same as a diagnosis of BPSD and will lead to too few patients reconceptualized as suffering from BPSD. We shall review the history and clinical characteristics of a patient with BPSD, only one of which (see Figure 1, item 8) refers to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM 5) criteria for a mixed state.

 

CNS Spectrums , Volume 27 , Issue 1 , February 2022 , pp. 4 – 6