Depression management

摘要

We feel the need to raise two key issues regarding the management of depression at a primary care level. First, the importance of recognising occult bipolar II disorder (depression with episodes of hypomania) in a primary care setting. Such patients often present with episodes of major depression and thus screening for symptoms of hypomania may be overlooked. Moreover, there may be a lack of recognition by the patient of their, often quite brief, hypomanic episodes particularly in their depressed state. The treatment for bipolar II disorder, however, differs significantly from that of patients with major depression: mood stabilisers versus antidepressants. Besides, treating bipolar II patients with the standard cocktail of antidepressants runs the risk of driving such individuals into rapid cycling and mixed affective states. Notably, these states are associated with a high risk of suicidality and hence the importance of not missing bipolar II disorder.