1. Identify bipolar depression.
2. Strategize the newest medications for bipolar depression.
3. Explore the role of adjunctive psychosocial treatment in bipolar depression
Dr.
Baldassano spent a large amount of time during her 3 hour workshop to help identify
bipolar depression (manic-depression in the old days), demographics and common misdiagnosis.
She discussed the common differential diagnosis issues, including unipolar
depression, ADHD, borderline personality disorder, schizoaffective disorder
etc. She pointed out that this disorder is commonly under diagnosed due to the
clinician failure to obtain a full family history or explore the possibility of
manic or hypomanic events. Bipolar disorder is episodic, versus other disorders
that may be chronic. Dr. Baldassano said
the clinician should not accept the “snapshot” presented early in the admission
interview but should assemble the whole “photo album” by the end of the
interview including the family history as corroborated by family members. She
emphasized the importance of including family members in diagnosis and
treatment.
Dr.
Baldassano mentioned a few interesting tidbits about bipolar disorder from the
research. The younger the onset, the worse will be the symptoms over a longer
period. She reminded the audience that depression is a “syndrome” not a
diagnosis. Depression may occur as a result of many physical and mental health
disorders over the lifespan. She also clarified the difference between different
types of bipolar disorder, and different manifestation of symptoms based on the
age of the patient. She also emphasized the high rate of suicides among bipolar
patients (25% above the general population).
On
a humorous note, Dr. Baldassano presented a slide that suggested that a “soft
sign” of bipolar disorder is someone who wears a red necktie, a red belt and
has a red car. After checking my own tie and belt, I was amused to note that
others around me were doing the same.
Although
medications to treat bipolar depression, have not dramatically changed in the past
couple of years, Dr. Baldassano presented research on the effectiveness of
medical treatment. She said that many antidepressant medications are at best, ineffective
in alleviating depressive symptoms in bipolar disorder, and at worst, may
trigger an increase in a manic episode cycle. She presented several research
studies, using placebo controls to illustrate her point. Dr. Baldassano did a
nice job of describing the research on medical treatments that are effective in
treating bipolar depression. She helped to explain the use of lithium. She
acknowledged the dangers of this medication, but she presented research to
demonstrate it’s effectiveness, especially in the reduction of suicides for
this population. She also demystified the use of electroconvulsive therapy
(ECT) as currently performed, stating that this is an effective treatment,
after medication has failed to alleviate symptoms.
Interesting,
but sad, Dr. Baldassano presented research suggesting that despite the
reduction of symptoms through current medical treatments, functionality of the
patient does not improve at the same rate.
Finally,
Dr. Baldassano discussed the effectiveness of non-medical treatments such as
Cognitive Behavioral Therapy (CBT) etc.
Her
workshop accomplished all three objectives to some extent, but fell a little
short on number 3 because of time constraints. As do many presenters, Dr.
Baldassano allowed questions throughout the presentation. She did ask that the questions
be kept short, and said that she would allow time for more questions at the end. After
the third lengthy question in the first 15 minutes, it occurred to me that some
in the audience did not understand her request. I knew that she would not be able to complete
her material and I suspected that Objective 3 would suffer. I was right. The
material for all three Objectives was in her handouts but she ran out of time.
Although
Dr. Baldassano answered all questions, some of the questions were very basic or
tangential to the topic and did not appear to be well thought-out. These
interrupted the flow of the workshop. Other questions were right to the point
and demonstrated an intermediate or advanced level of knowledge of the topic. These
enhanced the workshop. Perhaps the presenters
in the future should advertise the level of these workshops for Basic,
Intermediate, or Advanced audiences. What do you think?
