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Advances in Bipolar Depression: Differential Diagnosis, Comorbidities, and Contemporary Treatment Strategies

Advances in Bipolar Depression: Differential Diagnosis, Comorbidities, and Contemporary Treatment Strategies



Time to Complete

1 hour


August 31, 2017


August 31, 2018
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Maximum Credits

1.00 / AMA PRA Category 1 Credit(s)TM
1.00 / CE for Nurses (0.50 pharmacology credits)

Accredited Provider

This activity is jointly provided by Postgraduate Institute for Medicine and CMEology.

Commercial Supporter

This activity is supported by an educational grant from Sunovion Pharmaceuticals, Inc.

Program Description

Bipolar disorder is a complex illness, and its diagnosis and management remain among the most challenging facets of clinical psychiatry. Patients with bipolar disorder are most likely to present with depression and are often misdiagnosed with unipolar depression. Many patients wait years for a correct diagnosis. Distinguishing between unipolar and bipolar depression is often difficult, and the frequent occurrence of mixed features can make the differential diagnosis challenging.

Medical and psychiatric comorbidities are also common in patients with bipolar depression and complicate the diagnosis and treatment. Persons with bipolar disorder have a high incidence of metabolic syndrome and other cardiovascular risk factors, while obesity and inactivity are associated with more severe illness and poorer treatment outcomes. Anxiety disorders and substance use disorder are among the most common psychiatric comorbidities in patients with bipolar disorder. Accurate diagnosis and consideration of comorbidities can prevent inappropriate or ineffective pharmacotherapy.

This activity will provide insights to enhance healthcare providers’ knowledge of the accurate diagnosis and pharmacotherapeutic treatment of bipolar disorder. An expert faculty will discuss practical patient-centered strategies for diagnosis and management of bipolar depression, considerations for medical and psychiatric comorbidities, and evidence-based treatment strategies for bipolar depression.

Intended Audience

This activity has been designed to meet the educational needs of psychiatrists, advanced practice nurses, and other healthcare professionals involved in the care of patients with bipolar disorder.

Educational Objectives

At the conclusion of this activity, participants should be better able to:

  • Formulate a differential diagnosis of bipolar disorder, differentiating bipolar depression from unipolar depression, major depressive disorder and subsyndromal mania/hypomania, and other disorders
  • Implement strategies for treatment of patients with bipolar depression and comorbidities
  • Discuss the most recent developments in the diagnosis and treatment of bipolar disorder

Conflict Of Interest Disclosure Policy

Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COI are thoroughly vetted and resolved according to PIM policy. PIM is committed to providing its learners with high quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.

Faculty and Disclosures

Eduard Vieta, MD, PhD (Chairperson)
Professor of Psychiatry
Director of the Bipolar Disorders Program of the Hospital Clinic
University of Barcelona
Barcelona, Catalonia, Spain

Dr. Vieta has disclosed the following:
Consulting Fees (eg, Ad Boards): AB-Biotics, Ferrer, Gedeon Richter, Lundbeck, Otsuka, Sunovion Pharmaceuticals, Inc., Takeda
Contracted Research: AB-Biotics, Brain & Behavior Research Foundation, Ferrer, Gedeon Richter, Lundbeck, Otsuka, Sunovion Pharmaceuticals, Inc., Takeda, the Spanish Ministry of Science and Innovation (CIBERSAM), the Seventh European Framework Programme (ENBREC), and the Stanley Medical Research Institute

Andrew Nierenberg, MD
Thomas P. Hackett, MD, Endowed Chair in Psychiatry
Director, MGH Bipolar Clinic and Research Program
Director, Training and Education, MGH Research Institute
Associate Director, Depression Clinical and Research Program
Massachusetts General Hospital
Professor of Psychiatry, Harvard Medical School
Boston, MA, USA

Dr. Nierenberg has disclosed the following:
Receipt of Intellectual Property Rights/Patent Holder: Copyright joint ownership with MGH for Structured Clinical Interview for MADRS and Clinical Positive Affect Scale
Consulting Fees (eg, Ad Boards): Abbott Laboratories, Alkermes, AstraZeneca, Basilea Pharmaceutica, BrainCells, Inc., Bristol-Myers Squibb, Corcept Therapeutics, Eli Lilly & Co., Epi-Q, Genaissance, Genentech, GlaxoSmithKline, Hoffmann-La Roche, Innapharma, Janssen Pharmaceuticals, Jazz Pharmaceuticals, MedAvante, Merck, MSI Methylation Sciences Inc., Naurex, Novartis, NeuroRx, PGx, Pfizer, Ridge Diagnostics, Shire, Somerset Pharmaceuticals, Sunovion Pharmaceuticals, Inc., Takeda Pharmaceuticals, Teva Pharmaceutical Industries
Fees for Non-CME/CE Services Received Directly from a Commercial Interest or their agents: ADURS, American Society for Clinical Psychopharmacology, ASCP, AstraZeneca, Brain & Behavior Research Foundation, Brandeis University, Bristol-Myers Squibb, Cyberonics, Eli Lilly & Co, Forest Pharmaceuticals, GlaxoSmithKline, Guilford Press, Harold Grinspoon Charitable Foundation, Health New England, International Society of Bipolar Disorders, Janssen Pharmaceuticals, MBL Publishing; MGH Psychiatry Academy, NIMH, Parexel, Physicians Postgraduate Press, Shire, SLACK Incorporated, Takeda Pharmaceuticals, University of Pisa, University of Texas Southwest at Dallas, University of Wisconsin at Madison, Zucker Hillside Hospital
Contracted Research: Brain & Behavior Research Foundation, Bristol-Myers Squibb, Cederroth, Cyberonics, Forest Pharmaceuticals, GlaxoSmithKline, Janssen Pharmaceuticals, Lichtwer Pharma, Eli Lilly & Co., Marriott Foundation, NARSAD, NeuroRx, NIMH, Pamlab (now Alfasigma), PCORI, Pfizer, Shire, Stanley Foundation, Takeda Pharmaceuticals
Ownership Interest: Appliance Computing, Inc. (MindSite), BrainCells, Inc., MedAvante
Other Income: MBL Publishing for past services as Editor-in-Chief of CNS Spectrums; SLACK, Incorporated for services as Associate Editor of Psychiatric Annals; Editorial Board, Mind, Mood and Memory, Belvoir Publications

Trisha Suppes, MD, PhD
Professor, Department of Psychiatry and Behavioral Sciences
Stanford University School of Medicine
Director, VA Palo Alto Bipolar and Depression Research Program
VA Palo Alto Health Care System
Palo Alto, CA, USA

Dr. Suppes has disclosed the following:
Consulting Fees (eg. Ad Boards): Sunovion Pharmaceuticals, Inc.
Contracted Research: National Institutes of Health – NIMH, NIDA, NIH, Palo Alto Health Services, Pathway Genomics, Stanley Medical Research Institute, VA Cooperative Studies Program
Receipt of Intellectual Property Rights/Patent Holder: UpToDate

Planners' and Managers' Disclosures

The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP, have nothing to disclose.

The following CMEology planner and managers, Dana Ravyn, PhD, MPH, Rob Lowney, and Dannielle McGuire, hereby state that they or their spouse/life partner do not have any financial relationships or relationships to products or devices with any commercial interest related to the content of this activity of any amount during the past 12 months.




AMA PRA Category 1 Credit(s)TM

Accreditation Statement

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of Postgraduate Institute for Medicine and CMEology. Postgraduate Institute for Medicine is accredited by the ACCME to provide continuing medical education for physicians.

Designation Statement

Postgraduate Institute for Medicine designates this enduring material for a maximum of 1.00 AMA PRA Category 1 CreditsTM  . Physicians should claim only the credit commensurate with the extent of their participation in the activity.




CE for Nurses

Accreditation Statement

Postgraduate Institute for Medicine is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

Designation Statement

This educational activity for 1.00 contact hours is provided by Postgraduate Institute for Medicine. Designated for 0.50 contact hours of pharmacotherapy credit for Advance Practice Registered Nurses.

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.


Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

About the Art and Artist

L.B. Berman: A self-described minimalist who “sees beauty in simple complexity,” Lorrie (known as “L.B.”) works in watercolor. She is an artist living with bipolar disorder. She had no formal art training, but her parents exposed their children to art during forays to galleries and antique shops. Her first experience making art occurred when a therapist gave her a brush, paper, and paint and told her to “paint the blackness out; paint your emotions away.” She has worked as a professional designer and fabricator of copper and aluminum earrings.


In order to receive credit, participants must complete the pre-assessment questions, post-test, and program evaluation. Participants must also score at least 75% on the posttest. Certificates will be distributed online at the conclusion of the activity. Your online certificate will be saved on myCME within your Profile/CME History, which you can access at any time.

There is no fee to participate in this activity.

For information about the accreditation of this program, please contact Postgraduate Institute for Medicine at: (303) 799-1930 or via email at:


Hardware and Software Requirements
  • A computer with an internet connection
  • Internet Browser: Internet Explorer 7.x or higher, Firefox 4.x or higher, Safari 2.x or higher, or any other W3C standards compliant browser
  • Additional Software: Adobe Flash Player and/or an HTML 5 capable browser maybe required for video or audio playback. PowerPoint or Adobe Acrobat Reader may occasionally be required
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