Concept and Identification of "Soft Bipolarity" in Patients presenting with Depression: Need for Careful Screening by Physicians.

The bipolar spectrum is a broader concept, which questions the strict dichotomous categorical division of erstwhile manic-depressive illness into two discrete categories viz. bipolar disorder and major depressive disorder, thereby overlooking a wide 'spectrum' of patients which lie 'in between' the two extremes. The presence of underlying bipolar 'spectrum' or 'soft bipolarity' often goes undetected in patients presenting with major depression. This sub-group of patients may not stabilize with indiscriminate use of anti-depressant drugs, and without proper management, it may be associated with continued non-responsive symptoms, increased suicidality and poorer prognosis. There is a need to suspect and identify such cases of soft bipolarity/spectrum by early screening of patients with major depression presenting to medical settings. The review paper covers the current concepts and understanding of bipolar spectrum disorders which is aimed to facilitate early identification, management and referral of cases detected to have soft bipolarity in the general medical settings. © Journal of the Association of Physicians of India 2011.