Despite a prevalence of about 5% in the community and 50% in depressed outpatients, the treatment of bipolar II disorder* and related disorders is understudied. Recent advances in this area, which have mainly been related to these conditions, are discussed in a Seminar in The Lancet.
Franco Benazzi (Hecker Psychiatry Research Center, Forli, Italy) reviews the concepts, definitions, and classifications of bipolar and related disorders, with a focus on bipolar II disorder and mixed depression. He notes that the apparent increase in prevalence of bipolar spectrum might be related to several changes in diagnostic criteria, including improved probing for history of hypomania, lower minimum duration of hypomania, and inclusion of unipolar depressions with bipolar signs such as family history of bipolar disorder and mixed depression. He recommends caution in the treatment of mixed depression, for which some symptoms can be worsened by antidepressants and might be better controlled by initial treatment with mood stabilisers, although further evidence is needed.Franco Benazzi concludes: “Bipolar disorders, especially bipolar II and the related bipolar spectrum disorders, are much more common than previously reported, and treatment is much understudied. Controlled pharmacological studies are greatly needed, and should stratify samples taking into account the frequently mixed profile of bipolar disorders”.(Source: Lancet : Hecker Psychiatry Research Centre : March 2007.)