New guidelines to focus on mixed features in depression, bipolar

This more holistic way of thinking about depression is one I endorse. It makes sense to conceptualize bipolar disorder as a whole body disorder rather than a condition that is specific to the brain. The clinical implications are that we need to consider integration of care approaches that can reduce stress and inflammation generally, and minimize the complications of medical conditions seen in people with bipolar disorder. Some behavioral therapies are protective against inflammation and are recommended in the guidelines. These include attention to sleep, diet, and exercise. Social rhythm therapy is underutilized, as are other types of psychosocial approaches. Appropriate access to and use of medical care to help manage medical conditions is important, and integrated medical care that considers both body and mind may be helpful.

Martha Sajatovic, MD, is the Willard Brown Chair in Neurological Outcomes Research, and director of the Neurological Outcomes Center at the University Hospitals Case Medical Center in Cleveland. She is professor of psychiatry and of neurology at Case Western Reserve University, also in Cleveland. Dr. Sajatovic reported she has several industry relationships, including with Janssen, Merck, Ortho-McNeil, and Pfizer.