Differentiating Bipolar Disorder From Major Depressive Disorder

CE / CME

eCase: Differentiating Bipolar Disorder From Major Depressive Disorder: Clinical Conundrums and Treatment Recommendations

Physician Assistants/Physician Associates: 0.75 AAPA Category 1 CME credit

Social Workers: 0.75 ASWB ACE CE Credit

Pharmacists: 0.75 contact hour (0.075 CEUs)

Psychologists: 0.75 APA CE Credit

Nurses: 0.75 Nursing contact hour

Physicians: Maximum of 0.75 AMA PRA Category 1 Credit

Released: October 17, 2022

Expiration: October 16, 2023

Holly A. Swartz
Holly A. Swartz, MD

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Case Study: Annette

Annette comes to see you with a chief complaint of “I am feeling depressed.”

Annette is a 30-year-old woman working as nursing assistant in a local hospital. She completed high school and has 2 children, aged 11 and 9 years. She reports that during the past 2 months, she has been feeling “down.” She endorses low mood, low energy, increased sleep (9-10 hours per night), decreased interest in previously pleasurable activities such as gardening and cooking, a 5-lb weight gain, trouble concentrating, and passive suicidal ideation. She notes that she has missed several days of work because she didn’t want to get out of bed, and she is worried she might lose her job if she is not given “something to help me shake this off.”

She reports previous episodes of depression at ages 15, 21, 22, and 25 years with poor responses to trials of fluoxetine, citalopram, and venlafaxine. She felt “hyper” on fluoxetine, and none of them helped her depression. Annette states that her mother was diagnosed with BD and her father was “an alcoholic.” She endorses drinking 4-5 beers per week and uses cannabis daily.

What are some factors in Annette’s history that may lead you to suspect a diagnosis of BD?