Correspondence

Bipolar Disorder

N Engl J Med 2004; 351:2454-2455December 2, 2004

Article

To the Editor:

Belmaker (July 29 issue)1 reviews the syndrome of bipolar disorder. The lifetime prevalence of bipolar disorders among patients in primary care and general medical settings is considerably higher2 than the approximately 1 percent consistently reported in the general population.3 Patients with bipolar disorder are much more likely to seek help when they are depressed, and a history of manic or hypomanic symptoms can be easily missed. There is a significant risk of psychiatric complications when an antidepressant drug is prescribed without concurrent use of a mood stabilizer, such as lithium, in a patient with bipolar disorder. Therefore, it is important that primary care physicians ask any patients presenting with depression about a possible history of mood elevation and other manic symptoms4 and about a possible family history of bipolar disorder. As Dr. Belmaker points out, no clear personality traits specific to patients with bipolar disorder have been identified. However, a higher index of suspicion is probably justified in the case of patients who have symptoms of borderline personality disorder, such as frequent and sudden mood changes, impulsivity, interpersonal instability, and self-injury, because of the coexistence of the two disorders.5

Raz Gross, M.D., M.P.H.
Columbia University, New York, NY 10032
rg547@columbia.edu

Amar K. Das, M.D., Ph.D.
Stanford School of Medicine, Stanford, CA 94305

Myrna M. Weissman, Ph.D.
Columbia University, New York, NY 10032

5 References

1. 1

   Belmaker RH. Bipolar disorder. N Engl J Med 2004;351:476-486
   Full Text | Web of Science | Medline

2. 2

   Das AK, Gameroff MJ, Lantigua R, Shea S, Olfson M, Weissman MM. Bipolar spectrum disorders in Hispanic primary care patients. Presented at the Annual Meeting of the American Psychiatric Association New York, May 1–6, 2004.
   

3. 3

   Weissman MM, Bland RC, Canino GJ, et al. Cross-national epidemiology of major depression and bipolar disorder. JAMA 1996;276:293-299
   CrossRef | Web of Science | Medline

4. 4

   Das AK, Gross R, Weissman MM. Screening for depression in adults. Ann Intern Med 2003;138:767-768
   Web of Science | Medline

5. 5

   Gross R, Olfson M, Gameroff M, et al. Borderline personality disorder in primary care. Arch Intern Med 2002;162:53-60
   CrossRef | Web of Science | Medline