b'Bipolar Disorder Often MisdiagnosedAs Major Depression, Leading toImproper Treatment Nearly 70% of bipolar patients are initially misdiagnosed, usually with depression. Making the situation even more troubling is that antidepressants can destabilize mood.By Brenda L. MooneyALBUQUERQUE,NMMisdiagnosisofbipo- authors explained. It is unknown whether MDD is lardisorderisextremelycommon.Asurveybya comorbidity of BD or its earlier stage, and no con-theNationalDepressiveandManic-Depressivesensusexistsonindividualconversionpredictors, Association earlier this century found that 69% ofdelaying BDs timely recognition and treatment.patients with the condition are misdiagnosed initial- In response, the study team sought to create a pre-ly, and more than one-third remained misdiagnoseddictive model of MDD to BD conversion and then for 10 years or more. validate it across a multinational network of patient The problem is not only that patients continuedatabasesusingthestandardizationaffordedby to suffer and fail to improve without proper treat- theObservationalMedicalOutcomesPartnership ment. Major depressive disorder is among the most(OMOP) common data model.commondiagnosis,accordingtopastresearch,Todothat,researchersretrospectivelyanalyzed andcontroversyragesoverwhetherantidepres- fivetrainingU.S.databases:IBMMarketScan sants alone are effective at all in treating bipolarCCAE, MDCR, MDCD, Optum EHR and Optum depression and, even more fraught, whether theyClaims. In addition, external validation of the final destabilize mood. prediction model was performed across nine patient All of this has led to the phenomenon of patientsrecorddatabaseswithintheObservationalHealth transitioning from a diagnosis of major depressionDataSciencesandInformatics(OHDSI)network to bipolar disorder, often because of an initial mis- internationally. diagnosis. A new study in Translational PsychiatryThestudyreportedthatninevariablespredicted discussed the situation and offered a very practicalone-yearMDD-BDtransition.Increasingtherisk tool: an algorithm that can predict a patients risk ofwere:transitioning from a diagnosis of major depression to younger age, a diagnosis of bipolar disorder. 1severe depression, The effort, led by University of New Mexico Health psychosis, Sciences Center researchers, also included participa-anxiety, tion from the Tennessee Valley VA Healthcare System substance misuse, and VA Informatics and Computing Infrastructure at self-harm thoughts/actions, and the VA Salt Lake City Health Care System, as well as prior mental disorder. other U.S. and international institutions.An assessment algorithm was built for MDD to Many patients with bipolar disorder (BD) are ini- BD conversion that allows distinguishing as much tially misdiagnosed with major depressive disorderas100-foldriskdifferencesamongpatientsand (MDD) and are treated with antidepressants, whosevalidateswellacrossmultipleinternationaldata potential iatrogenic effects are widely discussed, thesources, the authors added.9'