Reply to Letter to the Editor "High Prevalence of Bipolar Spectrum Disorders"

Letter to the Editor

Sir: Dr. Benazzi raises some exceedingly important points regarding the diagnosis of bipolar spectrum illness. Currently, the DSM-IV nosology recognizes mania (type I) and hypomania (type II), but there is a large group of patients who are neither classically bipolar (type I) nor classically unipolar (no symptoms at all suggestive of hypomania). In my experience, many practitioners, especially those in private practice, treat a large group of patients in this category. If one were to use a DSM term, one would have to label these patients as having bipolar disorder, not otherwise specified (NOS). However, clinicians are sometimes hesitant to make NOS diagnoses because some insurance plans do not reimburse for NOS diagnoses. Thus, on rather unscientific grounds, many patients are getting labeled as having unipolar depression who do not classically fit those criteria.