Mayo Clinic psychiatrist Mark A. Frye, M.D., discusses how the work at the Mayo Clinic Depression Center is focused on providing a comprehensive diagnostic assessment and treatment recommendations for patients who struggle with treatment-resistant depression and bipolar disorder. It can be a challenging diagnosis to make, and the treatment options can be limited, but research is moving to optimize those options.
MARK FRYE: Hello. My name is Dr. Mark Frye. I'm a psychiatrist of Mayo Clinic. Our work at the Mayo Clinic Depression Center is really focused on providing a comprehensive diagnostic assessment and treatment recommendations for patients who struggle with treatment-resistant depression and bipolar disorder. The reality from the standpoint of diagnosing and treating bipolar depression is that it can be a challenging diagnosis to make. And at the end of the day when that diagnosis is made, our treatment options are limited, underscoring again, a second piece of the challenge of diagnosing and treating bipolar depression. As this New England Journal clinical practice series highlights, the diagnosis of bipolar depression is challenging-- two reasons, mainly-- most patients come to a clinic like the Mayo Clinic Depression Center complaining of depression. It is infrequent to have a patient come present for symptoms of mania or hypomania. That that happens in other avenues. The challenge for the clinician, when recognizing that a depression is there, is to really ascertain historically, has there been a manic, a BP I or hypomanic BP II episode historically? That is the challenge, as this case vignette clearly exemplifies. One of my teachers when I was a student was Hagop Akiskal. And this slide depicts a wonderful article of Hagop Akiskal reviewing the course of illness of major depressive disorder versus bipolar disorder, and by doing so, highlighting some variables, or clinical features, that we tend to see more frequently in an episode of bipolar depression in comparison to an episode of unipolar or major depressive disorder. And as you can see from Hagop's review article, that this can focus on age of illness onset, the speed of how symptoms develop over time, the presence or absence of atypical symptoms of depression, what we referenced to be hypersomnia, hyperphasia, the presence of psychomotor retardation, and lastly, some features related to family history and/or antidepressant drug responsivity. The reality is this is a challenging diagnosis. The treatment options are not as clear as they are for people who have the manic episode of bipolar disorder or major depressive disorder. But research desperately needed is going forward to try to best optimize these treatment selections. I'm Dr. Mark Frye. And thank you for listening.