Michael Ziffra, MD: Screenings for Bipolar Disorder

While much of the research in psychiatry goes into diseases like depression, anxiety, and schizophrenia, there remains a need to develop new drugs to help treat patients with bipolar disorder.

In a presentation during Pri-Med West 2022 in Anaheim, Michael Ziffra, MD, associate professor in the Department of Psychiatry at the Northwestern University School of Medicine, spoke about diagnosing bipolar disorder, potential pitfalls in making that diagnosis, and reviewing initial treatment strategies for the disease.

Ziffa spoke with HCPLive®, about some promising new treatments for bipolar disorder and what some of the gaps in research are.

HCPLive: Can you give you brief overview on your presentation at Pri-Med West 2022?

Ziffra: So I spoke about bipolar disorder, diagnosis of bipolar disorder and management of bipolar disorder in primary care settings.So basically giving the attendees a sense of what do they need to know in terms of how do they recognize it? What are things they can do to help treat it in their primary care settings?

HCPLive: How do you think the COVID-19 pandemic impacted screenings for diseases like bipolar disorder?

Ziffra: I think in general, bipolar disorder always has been under diagnosed and I think that's still the case today. A lot of the challenge comes from the fact that patients may not recognize their symptoms.

Bipolar disorder is something that we describe as a combination of episodes of depression with episodes of mania or hypomania. And patients obviously know when they're depressed, it's pretty obvious that they know that they're not feeling well, they're not functioning well.

But when patients are having episodes where they're feeling more manic, they may not recognize that as problematic because when a person has a manic episode, they may have more energy they may be more productive, they may feel euphoric.

They don’t recognize that as a sign of illness. Patients may not be reporting everything that's going on. And the other piece that makes things complicated is that patients with bipolar disorder they may have manic or hypomanic episodes, but the majority of their episodes are depressive.

When a patient comes to you, and they report as being depressed they might very well have bipolar disorder unless you ask the right question. So I think part of why it can get under diagnosed is if their treater is not asking the right screening questions to verify whether or not the person actually has bipolar disorder as opposed to run up the mill depression.

HCPLive: Is it difficult for patients to accept a bipolar disorder diagnosis compared to a depression diagnosis? Is this common?

Ziffra: It is. I do think this stigma is lessening over time, but it still happens. And I think that the way we can help patients with this is number one, to let them know that bipolar disorder really is a lot more common than people realize. And even though bipolar disorder can cause a lot of impairments if it's well treated, a person can still they can be highly functional. They can have a very full life.

They can work have a family do a lot of meaningful things, so it's very treatable and manageable.

And plus, I also often refer patients to groups out in the community. There's the Depression and Bipolar Support Alliance and Nami, the National Alliance on Mental Illness and that can help people who are newly diagnosed learn more about the diagnosis and find a community of people who are experiencing similar things and community who can help them understand the diagnosis and help them feel like there's less stigma about it.

HCPLive: What are the current gaps in research you want to see more focused in the next few years?

Ziffra: I think it would be great if we knew of more medications to help treat bipolar disorder. Most of the medications, the newer medications that have come out really are just slight variants of older drugs. So it would be nice to see newer classes of drugs out there. You know, there's the fact that there's a lot of research being done on servers psychedelics, psilocybin, LSD, Ayahuasca.

There's still a lot of research that needs to be done, but there definitely is some early research that has some promise. So if we can get some new therapeutics from those sorts of things, I think that'd be very helpful.

HCPLive: Do you think things like bipolar disorder or borderline personality disorder, other mood disorders, do you think they're under studied right now?

Ziffra: I don't know if I would say it's under studied. I think this we always could learn more.

Because bipolar disorder is a very complex illness. It can manifest in a lot of different ways. There are different variants, different types. of severity. So we always could learn more. Now and he also mentioned borderline personality disorder, that's it is important emphasize that's a very distinct diagnosis from bipolar disorder.

But that is a diagnosis that is also complex in a number of ways. And that is a diagnosis where there definitely is a lot more to learn in terms of the treatment is a little bit more complex because medication has a more limited role.

And often it's more psychotherapeutic interventions that ended up helping more. So learning how to most effectively manage borderline personality disorder, we definitely could use more research on that because it is also a very complex diagnosis.