Could bipolar disorder be diagnosed with a blood test?

British scientists have identified a biomarker that could distinguish bipolar disorder and major depressive disorder, it has been announced.

The biomarker highlights the different roles of lipid molecules called ceramides in these mood disorders.

Dr Jakub Tomasik of the University of Cambridge, UK, and his team aimed to find a biomarker in blood that could be tested during depressive episodes, to add to information provided by the patient.

“Bipolar disorder is frequently misdiagnosed as major depressive disorder because of overlapping symptoms and the lack of objective diagnostic tools,” they write in JAMA Psychiatry today.

So, the team analysed dried blood spot samples and questionnaire results from 241 patients measured between 2018 and 2020. Using mass spectrometry, the team measured 630 metabolites in the samples.

Among the patients, 28% were diagnosed with bipolar disorder and 72% with major depressive disorder.

“Combining biomarker data with patient-reported information significantly enhanced diagnostic performance,” the researchers report. “The identified biomarkers were correlated primarily with lifetime manic symptoms and were validated in a separate group of patients.”

They conclude: “This study provides a proof of concept for developing an accessible biomarker test to facilitate the differential diagnosis of bipolar disorder and 72% with major depressive disorder.”

Dr Tomasik said: “People with bipolar disorder will experience periods of low mood and periods of very high mood or mania. But patients will often only see a doctor when they’re experiencing low mood, which is why bipolar disorder frequently gets misdiagnosed as major depressive disorder.”

Co-author Professor Sabine Bahn added: “However, the two conditions need to be treated differently: if someone with bipolar disorder is prescribed antidepressants without the addition of a mood stabiliser, it can trigger a manic episode.”

Tomasik, J. et al. Metabolic Biomarker Signatures for Bipolar and Unipolar Depression. JAMA Psychiatry 25 October 2023; doi: 10.1001/jamapsychiatry.2023.4096

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