The following article is part of conference coverage from the 2019 American Association of Nurse Practitioners Annual Meeting (AANP 2019) in Indianapolis, Indiana. Clinical Advisor’s staff will be reporting breaking news associated with research conducted by leading nurse practitioners. Check back for the latest news from AANP 2019.


As bipolar depression is often associated with increased risk for suicide, long-term dysfunction, psychosocial impairment, and loss of work productivity, nurse practitioners (NPs) should be aware of the necessary screening and treatment options to more accurately diagnose and treat these patients, according to research presented at the American Academy of Nurse Practitioners (AANP) Annual Meeting, held June 18 to 23, 2019, in Indianapolis, Indiana.

Investigators conducted a literature search using the terms bipolar depression or bipolar disorder as well as other relevant terms such as prevalence, assessment, diagnosis, and treatment.

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Results revealed that up to 64% of clinical encounters for depression occur in primary care, with a reported 78% of primary care practitioners missing a bipolar disorder diagnosis. For patients with the disorder, mean delay between illness onset and clinician diagnosis is 5 to 10 years. Patients are often misdiagnosed with unipolar depression (60% of cases), which can lead to mistreatment with antidepressant monotherapy.

In order to prevent misdiagnosis, NPs should be aware of symptoms that are specific to bipolar depression, including: multiple prior episodes, family history, prior mania, and symptoms of unipolar depression such as long episode duration and somatic complaints. Approximately 60% of patients with bipolar disorder have a lifetime diagnosis of substance use disorder (SUD); therefore, SUD screening should be implemented when assessing for bipolar depression. 

Current treatments approved by the US Food and Drug Administration for bipolar depression include quetiapine, fluoxetine/olanzapine, and lurasidone, with quetiapine approved for both bipolar mania and depression. Although not approved, lithium and lamotrigine are often used for treatment.

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“Nurse practitioners who can differentiate presenting symptoms of bipolar depression and offer appropriate treatment options will be able to more accurately identify and manage these patients in clinical practice,” the authors concluded. Disclosure:  The authors are employed by Allergan.

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Wilson A, Patel M. Diagnosis and management of bipolar depression: an overview for nurse practitioners. Presented at: The American Association of Nurse Practitioners (AANP) Annual Meeting; June 18-23, 2019; Indianapolis, IN. Poster 5.