Latest Treatments of Bipolar Depression
Today’s workshop on the “Latest Treatments of Bipolar Depression,” by Claudia Baldassano, M.D., was advertised to meet three learning objectives.
1. Identify bipolar depression.
2. Strategize the newest medications for bipolar depression.
3. Explore the role of adjunctive psychosocial treatment in bipolar depression
Dr. Baldassano spent a large amount of time during her 3 hour workshop to help identify bipolar depression (manic-depression in the old days), demographics and common misdiagnosis. She discussed the common differential diagnosis issues, including unipolar depression, ADHD, borderline personality disorder, schizoaffective disorder, etc. She pointed out that this disorder is commonly under diagnosed due to the clinician failure to obtain a full family history or explore the possibility of manic or hypomanic events. Bipolar disorder is episodic, versus other disorders that may be chronic. Dr. Baldassano said the clinician should not accept the “snapshot” presented early in the admission interview but should assemble the whole “photo album” by the end of the interview including the family history as corroborated by family members. She emphasized the importance of including family members in diagnosis and treatment.
Dr.Baldassano mentioned a few interesting tidbits about bipolar disorder from the research. The younger the onset, the worse will be the symptoms over a longer period. She reminded the audience that depression is a “syndrome” not a diagnosis. Depression may occur as a result of many physical and mental health disorders over the lifespan. She also clarified the difference between different types of bipolar disorder, and different manifestation of symptoms based on the age of the patient. She also emphasized the high rate of suicides among bipolar patients (25% above the general population).
On a humorous note, Dr. Baldassano presented a slide that suggested that a “soft sign” of bipolar disorder is someone who wears a red necktie, a red belt and has a red car. After checking my own tie and belt, I was amused to note that others around me were doing the same.
Although medications to treat bipolar depression, have not dramatically changed in the past couple of years, Dr. Baldassano presented research on the effectiveness of medical treatment. She said that many antidepressant medications are at best, ineffective in alleviating depressive symptoms in bipolar disorder, and at worst, may trigger an increase in a manic episode cycle. She presented several research studies, using placebo controls to illustrate her point. Dr. Baldassano did anice job of describing the research on medical treatments that are effective intreating bipolar depression. She helped to explain the use of lithium. She acknowledged the dangers of this medication, but she presented research to demonstrate it’s effectiveness, especially in the reduction of suicides for this population. She also demystified the use of electroconvulsive therapy (ECT) as currently performed, stating that this is an effective treatment, after medication has failed to alleviate symptoms.
Interesting, but sad, Dr. Baldassano presented research suggesting that despite the reduction of symptoms through current medical treatments, functionality of the patient does not improve at the same rate.
Finally, Dr. Baldassano discussed the effectiveness of non-medical treatments such as Cognitive Behavioral Therapy (CBT) etc.
Her workshop accomplished all three objectives to some extent, but fell a little short on number 3 because of time constraints. As do many presenters, Dr. Baldassano allowed questions throughout the presentation. She did ask that the questions be kept short, and said that she would allow time for more questions at the end. After the third lengthy question in the first 15 minutes, it occurred to me that some in the audience did not understand her request. I knew that she would not be able to complete her material and I suspected that Objective 3 would suffer. I was right. The material for all three Objectives was in her handouts but she ran out of time.
Although Dr. Baldassano answered all questions, some of the questions were very basic or tangential to the topic and did not appear to be well thought-out. These interrupted the flow of the workshop. Other questions were right to the point and demonstrated an intermediate or advanced level of knowledge of the topic. These enhanced the workshop. Perhaps the presenters in the future should advertise the level of these workshops for Basic, Intermediate, or Advanced audiences. What do you think?