In order to prescribe the correct treatment for depressive disorder, it is necessary to distinguish between depression within the framework of recurrent depressive disorder and bipolar disorder. This tactic is justified both from a clinical point of view and knowledge of the biological causes of depression.
From a clinical point of view, separation allows depression to be properly treated and, in bipolar disorder, to prevent the risks of mania.
But the differential diagnosis of recurrent depressive disorder and bipolar depression is difficult.
Data from US researchers indicate that 50% of young patients diagnosed with recurrent depression then had at least one manic episode. H. Akiskal defined this course of the disease as “false unipolar disorder”. 10.7-27.4% of patients with episodes of depression are misdiagnosed as recurrent depressive disorder instead of bipolar disorder. These errors are associated with imperfect diagnostics, shortcomings of the ICD-10 classification. When diagnosing an affective disorder, the age of the first episode, the course of the disease, and the genetic factor are not taken into account. The objectification of the diagnosis can be increased using the G.Sachs bipolarity index .
This index allows you to identify and assess the characteristics of bipolar disorder. BAR prevalence is high, so you need a screening examination of all patients with depression with the aid of various scales and questionnaires. 73% of patients with bipolar disorder were misdiagnosed, and the correct diagnosis was made after 8 years. Women who develop bipolar disorder at a young age can die 5 years earlier, lose 12 years of healthy life and 14 years of normal social functioning.
At the first visit of a patient with bipolar disorder , he is mistakenly diagnosed with schizophrenia, recurrent depression, and alcohol dependence. Sometimes it takes 10 years to get a correct diagnosis. Patients with bipolar disorder have painful manifestations of depression for about half of their lives.
Bipolar disorder often has psychotic episodes that are difficult to distinguish from schizoaffective disorder and schizophrenia, personality disorder, and psychotropic drug abuse. Difficulties in diagnosis lead to inadequate therapy with antidepressants and antipsychotics, which worsens the patient’s condition.
Thus, the search for objective criteria for the differential diagnosis of depressive disorder based on the identification of foci of dysfunction in the brain zones, analysis of mediators and neurotransmitters , seems to be a promising direction.