Depressed, Borderline, or Bipolar?

Presenter: Brian Quinn, Ph.D., LCSW 
brianquinnphd.com

CEUs: Category 1 | 3.0 

Clinicians are seeing an increasing number of adolescents and young adults who, in spite of treatment with multiple antidepressants and a variety of other medications, remain mired in depression, often accompanied by irritability, anxiety, and distractibility. These individuals often lament that they “have tried every drug there is” without substantial or sustained benefit.

One reason for their predicament is that many of them are not simply depressed. At least 40 percent of them actually have unrecognized bipolar illness. Antidepressants have been shown to be only marginally better than placebo in acute bipolar depression and have been proven ineffective in preventing future depressive episodes in those with bipolar illness. In a subset of bipolar patients, antidepressants can cause or worsen irritable, agitated depression, increase the risk of suicide, and, paradoxically, lead to more frequent depressive episodes. Effective psychotherapy often proves to be difficult, if not impossible, when bipolar patients are misdiagnosed and inappropriately treated with antidepressants.

This seminar will provide clinicians with a four-part, clinical diagnostic method to distinguish patients with borderline personality and major depressive disorder from those with bipolar illness. Clinicians will learn about the medications that should form the foundation of treatment for bipolar illness, including the one medication that has been repeatedly shown to dramatically reduce the risk of completed suicide. They will also learn about potent, non-drug treatments for depression, mania, and rapid-cycling that they can put to immediate use in their practices.

Workshop Objectives:

Participants will learn:

1. The four lines of clinical evidence that must be assessed to distinguish bipolar depression from unipolar depression and borderline personality
2. A key issue to address in the psychotherapy of bipolar illness: Denial of the illness
3. The research showing why antidepressants are the wrong treatment for bipolar depression
4. The one drug repeatedly shown to dramatically reduce the risk of suicide
5. Why atypical antipsychotics should not be used in place of lithium and other drugs proven to prevent new episodes of depression and mania

Agenda:

Depression: Unipolar or bipolar? (and why it matters)

• Case study, with video: A TV reporter with undiagnosed bipolar illness
• Why and how you should check for a history of hypomania
• Common, but often overlooked: mixed depressive states
• Beyond symptoms: Why an evaluation of family history, course of illness,
• and response to antidepressants is critical to diagnosis and treatment
• A presidential candidate's family history and a teen on Zoloft who
• committed suicide: What their stories tell us about diagnosis

Differential Diagnosis: Bipolar Disorder and Borderline Personality

• Similarity/differences in symptoms
• Course markers that help distinguish bipolar illness from borderline
• Family history markers
• Helping patients accept the bipolar diagnosis and the need for medication

Medications

• Antidepressants and bipolar depression
• Lithium: Still important - and still the best for many patients
• Lamictal: Not all it's cracked up to be
• Why atypical antipsychotics are not mood stabilizers