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Bipolar Depression - Differential Diagnosis in the Community

neuroscienceCME Chart Review

Premiere Date: Wednesday, April 24, 2013

This activity offers CE credit for:

  1. Physicians (CME)
  2. Nurses (CNE)
  3. Pharmacists (ACPE)
  4. Other

All other clinicians will receive a Certificate of Attendance stating this activity was certified for AMA PRA Category 1 Creditâ„¢

Credit Expiration Date:
Sunday, April 24, 2016
Note: Credit Is No Longer Available


Charles B. Nemeroff, MD, PhDCharles B. Nemeroff, MD, PhD 
Professor and Chair
Department of Psychiatry
Mulva Clinic for the Neurosciences
Director, Institute of Early Life Adversity Research
Dell Medical School
The University of Texas at Austin
Austin, TX

Joseph R. Calabrese, MDJoseph R. Calabrese, MD 
Bipolar Disorders Research Chair and Professor of Psychiatry
Case Western Reserve University School of Medicine
Director, Mood Disorders Program
University Hospitals Case Medical Center
Cleveland, OH

Statement of Need

More than one in five primary care patients with depression have bipolar disorder, a recurrent and sometimes chronic illness involving episodes of depression and mania or hypomania. The most frequent presentation is depression; mania, as a presentation, is much less frequently encountered in physicians' offices, both primary care and psychiatric. Bipolar depression is often missed in these situations. About half of patients with bipolar disorder have consulted three or more health care professionals before receiving a correct diagnosis, and the average time to first treatment is 10 years.(1)

It is imperative that clinicians carefully assess patients for bipolar disorder, especially those presenting with depression. In addition to taking patient and family histories, administration of a screening instrument can be very helpful.(2) The most widely used screening tool in outpatient clinics and the community is the Mood Disorder Questionnaire. This screening tool can help clinicians make a differential diagnosis of bipolar vs. unipolar depression.(1)

This neuroscienceCME Chart Review will guide clinicians to differentiate the types of depression that can present in the community and also highlight screening tools that can improve recognition of bipolar depression.

  1. Hirschfeld RM. Screening for bipolar disorder. Am J Manag Care. 2007;13(7 Suppl):S164-S169. PMID: 18041877.
  2. Rogers J, Agius M, Zaman R. Diagnosis of mental illness in primary and secondary care with a focus on bipolar disorder. Psychiatr Danub. 2012;24(Suppl 1):S86-S90. PMID: 22945195.

Join Dr. Nemeroff on June 26, 2013 at 12:00 PM ET for part 2 of the neuroscienceCME Chart Review series when the patient case will focus on clinical management of bipolar depression. Register Now!

Activity Goal

The goals of this activity are to improve the recognition and diagnosis of bipolar depression and to increase the use of a screening tool to aid diagnosis.

Learning Objectives

At the end of this CE activity, participants should be able to:

  • Evaluate patients who present with depressive symptomatology for bipolar depression.
  • Regularly use a screening tool to assist in evaluating bipolar depression.

The following learning objectives pertain only to those requesting CNE or CPE credit:

  • Acknowledge that bipolar depression is often missed as a diagnosis in community offices.
  • Review screening tools that help evaluate depression.

Financial Support

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

Target Audience

Physicians, physician assistants, nurses, nurse practitioners, pharmacists, social workers, certified case managers, and all health care professionals who evaluate individuals for mood disorders.

Credit Information

CME Credit (Physicians):
CME Outfitters, LLC, is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

CME Outfitters, LLC, designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Creditâ„¢. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

CNE Credit (Nurses):
Provider approved by the California Board of Registered Nursing, Provider Number CEP 15510, for 1.0 contact hour.

CCMC Credit (Certified Case Managers):
This program has been approved for 1 hour by the Commission for Case Manager Certification (CCMC).

CPE Credit (Pharmacists):
ACPE CME Outfitters, LLC, is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. 1.0 contact hours (0.1 CEUs)
Universal Activity Number: 0376-0000-13-002-L01-P (live programs)
0376-0000-14-011-H01-P (recorded programs)
Activity Type: knowledge-based

Post-tests, credit request forms, and activity evaluations must be completed online at (requires free account activation), and participants can print their certificate or statement of credit immediately (80% pass rate required). This website supports all browsers except Internet Explorer for Mac. For complete technical requirements and privacy policy, visit

Disclosure Declaration

It is the policy of CME Outfitters, LLC, to ensure independence, balance, objectivity, and scientific rigor and integrity in all of their CE activities. Faculty must disclose to the participants any relationships with commercial companies whose products or devices may be mentioned in faculty presentations, or with the commercial supporter of this CE activity. CME Outfitters, LLC, has evaluated, identified, and attempted to resolve any potential conflicts of interest through a rigorous content validation procedure, use of evidence-based data/research, and a multidisciplinary peer review process. The following information is for participant information only. It is not assumed that these relationships will have a negative impact on the presentations.

Dr. Nemeroff has disclosed that he receives grants/research support from the Agency for Healthcare Research and Quality (AHRQ) and the National Institutes of Health (NIH). He serves as a consultant to Allergen, Inc.; Eli Lilly and Company; SK Pharma; Roche; Takeda Pharmaceuticals North America, Inc.; and Xhale, Inc. He serves on the scientific advisory boards of the American Foundation for Suicide Prevention (AFSP); Anxiety Disorders Association of America (ADAA); CeNeRx BioPharma; National Alliance for Research on Schizophrenia and Depression (NARSAD); PharmaNeuroBoost; Xhale, Inc.; Skyland Trail; and AstraZeneca Pharmaceuticals (2009). He serves on the board of directors of the American Foundation for Suicide Prevention (AFSP); Anxiety Disorders Association of America (ADAA); Gratitude America; Cook Pharma, Inc. (2010); NovaDel Pharma, Inc; and Skyland Trail. He is a stockholder of CeNeRx BioPharma; NovaDel Pharma, Inc., PharmaNeuroBoost; Reevax Pharmaceuticals LLC; and Xhale, Inc. His other financial Interests include CeNeRx BioPharma and PharmaNeuroBoost. He holds patents for the following: method and devices for transdermal delivery of lithium (US 6,375,990B1); method of assessing antidepressant drug therapy via transport inhibition of monoamine neurotransmitters by ex vivo assay (US 7,148,027B2).

Dr. Calabrese has disclosed that he has received research/grant support from Sunovion Pharmaceuticals Inc. He has presented on behalf of the American Foundation for Suicide Prevention and serves on the speakers bureaus for AstraZeneca; Benecke; Lundbeck; Medwiz Healthcare; ProMedica; and Spriant Communication Pvt. Ltd. He serves as a consultant for Biomedical Development Corporation; Convergent Health Solutions, LLC; Elan Health & Wellness; Hoffman-LaRoche Inc.; Lundbeck; Otsuka America, Inc.; Scienta; and Takeda Pharmaceutical USA, Inc. He has disclosed other financial or material support from Academia; Ohio Psychiatric Association; Ohio State University; University of Cincinnati; and University of Toronto.

Tony Graham, MD (content/peer reviewer) has no disclosures to report.

Ruth Cody, BSN, RN-BC (content/peer reviewer) has no disclosures to report.

Robert Kennedy (planning committee) has no disclosures to report.

Joy Bartnett Leffler, MLA, NASW, CSE (planning committee) has no disclosures to report.

Sandra Haas Binford, MAEd (planning committee) has no disclosures to report.

Sharon Tordoff, CCMEP (planning committee) has no disclosures to report.

Unlabeled Use Disclosure

Faculty of this CE activity may include discussions of products or devices that are not currently labeled for use by the FDA. The faculty have been informed of their responsibility to disclose to the audience if they will be discussing off-label or investigational uses (any uses not approved by the FDA) of products or devices.

CME Outfitters, LLC, the faculty, and Sunovion Pharmaceuticals Inc. do not endorse the use of any product outside of the FDA labeled indications. Medical professionals should not utilize the procedures, products, or diagnosis techniques discussed during this activity without evaluation of their patient for contraindications or dangers of use.

Questions about this activity? Call us at 877.CME.PROS (877.263.7767).


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