Needs Assessment: Major depressive disorder is a heterogeneous condition that often does not respond to standard therapies. Much recent attention has focused on a spectrum of subsyndromal presentations of bipolar disorder as one of the principal sources of such heterogeneity. As patients with bipolar depressions are not particularly responsive to antidepressants and are often misdiagnosed as suffering from major depressive disorder, it stands to reason that the pool of patients with treatment-resistant depression is overrepresented with patients with unrecognized bipolar disorder. Recognition of bipolar-spectrum depressions can result in important revisions in the treatment plan.
• Recognize the relationship between bipolar affective disorder and treatment-resistant depression.
• Discuss the concept of bipolar spectrum disorder.
• Describe appropriate treatment strategies for antidepressant nonresponders with bipolar-spectrum depressions.
Target Audience: Primary care physicians and psychiatrists.
CME Accreditation Statement: This activity has been planned and implemented in accordance with the Essentials and Standards of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the Mount Sinai School of Medicine and MBL Communications, Inc. The Mount Sinai School of Medicine is accredited by the ACCME to provide continuing medical education for physicians.
Credit Designation: The Mount Sinai School of Medicine designates this educational activity for a maximum of 3 AMA PRA Category 1 Credit(s)TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Faculty Disclosure Policy Statement: It is the policy of the Mount Sinai School of Medicine to ensure objectivity, balance, independence, transparency, and scientific rigor in all CME-sponsored educational activities. All faculty participating in the planning or implementation of a sponsored activity are expected to disclose to the audience any relevant financial relationships and to assist in resolving any conflict of interest that may arise from the relationship. Presenters must also make a meaningful disclosure to the audience of their discussions of unlabeled or unapproved drugs or devices. This information will be available as part of the course material.
This activity has been peer-reviewed and approved by Eric Hollander, MD, chair at the Mount Sinai School of Medicine, and Norman Sussman, MD, editor of Primary Psychiatry and professor of psychiatry at New York University School of Medicine. Review Date: October 18, 2006.
Dr. Hollander reports no affiliation with or financial interest in any organization that may pose a conflict of interest. Dr. Sussman is a consultant to and on the advisory boards of GlaxoSmithKline and Wyeth; and has received honoraria from AstraZeneca, Bristol-Myers Squibb, GlaxoSmithKline, and Wyeth.
To receive credit for this activity: Read this article and the two CME-designated accompanying articles, reflect on the information presented, and then complete the CME quiz. To obtain credits, you should score 70% or better. Release date: November 2006. Termination date: November 2008. The estimated time to complete all three articles and the quiz is 3 hours.
Primary Psychiatry. 2006;13(11):59-67