Better treatment for depression
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* Barry Rich

Patrick’s recent editorial1 on the need for more awareness for major depressive disorder forgets to mention the sorry case of major depressive disorder’s ugly stepsister, bipolar disorder.

An estimated 40% of people with major depressive disorder actually have bipolar disorder. The typical patient with bipolar disorder waits 10 years or more from first symptoms to correct diagnosis (it is difficult to diagnose a condition that is rarely acknowledged).

Even in the tragic case of Robin Williams, the public conversation was focused entirely on depression and substance abuse. Not a word about bipolar disorder.

The correct diagnosis is important because treatment for the two disorders is entirely different. Antidepressants can actually make bipolar disorder worse.

It is my firm conclusion that every person diagnosed with major depressive disorder should be reinterviewed, specifically to rule out the diagnosis of bipolar disorder. Think of all the lives, jobs and families that would be saved by incorporating this one “functional inquiry” into our diagnostic process.

Patrick1 referenced the recent research indicating that in major depressive disorder, antidepressants may be no better than placebo. Perhaps their results would be more reliable if those “confounding” patients with bipolar disorder were split off from the crowd.

## Reference

1.  Patrick K. Depression deserves better treatment. CMAJ 2014;186:1043.
    
    [FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiY21haiI7czo1OiJyZXNpZCI7czoxMToiMTg2LzE0LzEwNDMiO3M6NDoiYXRvbSI7czoyMjoiL2NtYWovMTg3LzYvNDM4LjMuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9)