From a diagnostic perspective, bipolar disorder is complex, highly nuanced and does not lend itself to black-or-white judgments. As a profession, we are in transition to a different diagnostic system known as the “bipolarity index.” This index will focus on a series of manic and non-manic bipolar markers scored on a point system, eschewing the oversimplified yes-or-no categorical system of the DSM.
The diagnosis of bipolar disorder in children and adolescents is currently the most hotly debated issue in pediatric mental illness. It is enormously controversial and depending on who you listen to, it has either reached epidemic proportions or it is virtually non-existent. Misdiagnosis is the major problem; whether the disorder is overdiagnosed or underdiagnosed only fuels controversy and is the wrong question anyway.
Lithium continues to demonstrate high efficacy as a first line agent for the treatment of bipolar disorder. It seems to be more effective for mania than bipolar depression. Lithium is more effective than Depakote as monotherapy for bipolar disorder; symptom improvement is only marginal when both are used together.
Seroquel and Abilify are emerging stars in the treatment of bipolar depression. Some studies indicate robust results with Seroquel.
Traditional antidepressants have little if any benefit in the management of bipolar depression.
The nuances of study design do not yet support second generation antipsychotics as first line agents for bipolar disorder.