"Bipolar Family"

Sir: When depression is preceded by a history of manic, mixed, or hypomanic episode, classifying it as bipolar depression rather than unipolar depression becomes straightforward. However, when there is no access to such history and the initial presentation is from the depressive end of the pole, correctly classifying the disorder as bipolar rather than unipolar then becomes difficult. Being able to correctly classify depression as bipolar rather than unipolar is crucial due to the ramifications of the diagnosis in terms of management. For example, it has been recommended that the depressive period of uncomplicated bipolar disorder should be treated for shorter periods than that for unipolar depression.1 Whereas in unipolar depression antidepressant monotherapy may be appropriate, in bipolar depression, without coupling it with a mood stabilizer, it may precipitate a “manic switch” and create a state of chronic irritable dysphoria and possibly a long-term rapid-cycling course. Due to symptomatic similarity between the 2 diagnostic entities, no particular symptom invariably distinguishes between the 2 disorders. However, if residents, psychiatrists, and family physicians can maintain a high index of suspicion, then certain factors from the past or present history would indicate that the depressive episode is more likely to be bipolar rather than unipolar. We describe the mnemonic “Bipolar Family” to remind clinicians of factors or symptom clusters that would make a depressive episode more likely to be bipolar rather than unipolar (Table 1). Table 1. “Bipolar Family”: Factors That Make a Depressive Episode More Likely To Be Bipolar Rather Than Unipolara In view of the significant difference in treatment3 and despite the similarity in presentation, we hope that residents, psychiatrists, and primary care clinicians will utilize this mnemonic as a screening tool when faced with a patient who primarily presents with a depressive episode.