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Medicalising, differentiating between major depressive and bipolar disorder.

Many patients with bipolar disorder, a debilitating mental condition that can take a person from the sluggishness of severe depression to super-human energy levels, are often misdiagnosed as having major depressive disorder, or MDD.  One reason is that the condition often first becomes noticeable when the patient has a bout of depression. And, as bipolar disorder only affects about 1% of the population worldwide, clinicians sometimes forget to ask about hypomania, a euphoric, hyperactive state that also characterizes the condition.  Now, a study from researchers at Chongqing Medical University has identified a panel of biomarkers that were able to differentiate between the two disorders with unprecedented accuracy.  The team state that their study brings researchers closer to an objective test that could help distinguish between the two, and provide better treatment, providing a far accurate alternative to patient interviews.

Previous studies show that the usual diagnostic techniques involve structured interviews with patients, however these have been proven to be subjective and misleading. An accurate diagnosis, however, is crucial to quickly getting patients the treatment they need.  The majority of bipolar disorder patients referred to psychiatric clinics are in the depression phase so they do not show symptoms of hypomania, and may be incorrectly diagnosed as MDD. Hence, better identification of symptoms and differentiation between these two types of disorders is important in choosing a suitable treatment and preventive measures. Therefore, the lab set out to develop an objective way to tell the difference between MDD and bipolar disorder.

The current study combined a couple of techniques, gas chromatography-mass spectrometry and nuclear magnetic resonance, to analyze urine metabolites in samples from 126 patients who either had MDD or bipolar disorder. Results show a total of 20 differential metabolites responsible for the discrimination between MDD and bipolar disorder subjects were identified.  Data findings show a panel consisting of six candidate urinary metabolite biomarkers were identified. This panel could distinguish bipolar disorder from MDD subjects with an accuracy of 89-91% in the training and testing sets, respectively.

The team surmise that their results reveal divergent urinary metabolic phenotypes between MDD and bipolar disorder. For the future, the researchers state that the identified urinary biomarkers can aid in the future development of an objective laboratory-based diagnostic test for distinguishing bipolar disorder from MDD patients.

Source: American Chemical Society

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