It takes an average of six years from the first appearance of bipolar symptoms to people with the condition being diagnosed and having their condition managed. The gap may have a serious effect on long-term outcomes, warned the author of a meta-study in the Canadian Journal of Psychiatry.
Professor Matthew Large of the University of New South Wales is senior author of a review of 27 studies, covering a total of 9,415 patients. These studies attempted to establish when people who had been diagnosed with bipolar disorder had first shown symptoms that went unidentified. Results varied but averaged 5.8 years.
"This is a lost opportunity because the severity and frequency of episodes can be reduced with medication and other interventions," Large said in a statement. "While some patients, particularly those who present with psychosis, probably do receive timely treatment, the diagnosis of the early phase of bipolar disorder can be difficult."
The earliest studies included were published in 1979, but most were from the last decade and conducted in Europe or the US, although there were two from Turkey and one from Thailand. Large told IFLScience the studies used a number of methods to estimate when symptoms started. “The most prevalent [method] is to ask the patients, although that is subject to recall bias." Other methods included documentary evidence, for example records of patients presenting to hospital with psychosis that was wrongly diagnosed at the time. Some teams interviewed friends and families of those affected.
Unfortunately, we know surprisingly little about the consequences of delay. “Bipolar is a very undeveloped field compared to schizophrenia, where we know there are modest benefits from earlier treatment,” Large told IFLScience. At the moment, treatment options are limited to mood stabilizers, which have serious side-effects for most of those who take them.
The study changed Large's view on bipolar diagnosis. “I thought the gap would be two or three years,” he said. The long timeline provides support for the theory propounded by some clinicians that bipolar disorder is greatly underdiagnosed, with many people presenting with bipolar symptoms being classified as schizophrenic or experiencing major depressive disorder instead.
“When we talk to patients, they often say they have found ways of managing mood, in much the same way alcoholics do,” Large said. Earlier diagnosis might make developing these techniques easier. "We know stress precipitates bipolar incidents, and while we can't prevent stress, we know exercise and talking to others can help people deal with it." A diagnosis could also be a warning to avoid drugs, but biological tests and specific treatments targeting genetic markers are a long way off.
In the statement, Large attributed the delay to the fact that reliable diagnosis "relies on a detailed life history and corroborative information from carers and family, information that takes time and care to gather.” Online tests are available for those with concerns, and while they are not definitive, can be useful guides as to whether to seek professional assessment.