How do you screen for unrecognized bipolar disorder before initiating antidepressant therapy in a patient presenting with a new depressive episode?

Because 60% of the index mood episodes with which children/adolescents (who will later be diagnosed with bipolar disorder) present are major depressive episodes, this is a very good question. It is important that clinicians do not precipitate a manic episode while treating a first depressive episode...

I really like the Mood Disorder Questionnaire (MDQ). In addition to just using a score, I carefully follow up on any positive answers. For me, one of the most important questions is, have you ever had a decreased need for sleep, making sure it’s in the absence of any substance use.

I like James Phelps’ books on understanding the spectrum of mood disorders. He has many guidelines about how to tease out unipolar from bipolar disorders. He sees them on a continuum rather than as separate entities. Good reading for sure.

A good o evaluation face to face can elicit many traits that clarify dx

History of few hrs of sleep and still being energetic

or several nights of less or no sleep then crashing

lot of patients tell you that was only in college, please don’t ignore it

history of spending etc running up the charge card...

In my experience, a postpartum psychotic depression often turns out to be bipolar depression rather than unipolar.

I do not use a screening scale, and I do not think mental health professionals can justify their use of screening scales.

There are no special questions on screening scales that mental health professionals are unaware. So the question is why use a self-administered screening scale instead of asking ...