Bipolar disorder laboratory findings

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Nuha Al-Howthi, MD[2]

No laboratory test is required to establish the diagnosis of bipolar disorder. However, laboratory tests can help to exclude alternative etiologies for mood symptoms. Laboratory tests may include a urine toxicology screen and a complete blood count. Fasting glucose and lipid assessments are important for establishing the presence of diabetes or hyperlipidemia.

• There are no diagnostic laboratory findings associated with Bipolar disorder. However, bipolar disorder enclose both depression and mania and it could be due to many reversible causes, an extensive range of tests is indicated^[1]
• Many number of medications that used to treat bipolar disorder have many side effect, for instance lithium requires an intact genitourinary system and can affect certain other systems.^[2]
• A complete blood count with differential is to rule out anemia as a cause of depression in bipolar disorder.^[3]
• Erythrocyte sedimentation rate to look for any underlying disease process such a lupus or an infection.
• Fasting blood glucose level is indicated to rule out diabetes, as well as atypical antipsychotics are associated with weight gain and trouble with blood glucose regulation in patients with diabetes.^[4]
• Patients that will be on lithium therapy checking electrolytes is indicated, because low sodium levels may lead to higher lithium levels and lithium toxicity.
• Check the serum calcium as any changes in serum calcium is associated with mental status changes (eg, hyperparathyroidism). An elevated calcium blood level can cause depression or mania.^[5]
• In patients with depression as a result of not eating, low serum protein levels increase the availability of certain medications, because these drugs have less protein to which to bind.
• Thyroid function tests to rule out hyperthyroidism (mania) and hypothyroidism (depression). lithium can cause hypothyroidism, for that thyroid tests should be obtained.^[6]
• In a study, they found out that patients with bipolar disorder are two times more commonly associated with thyroid dysfunction than individuals without bipolar disorder.^[7]
• Creatinine and blood urea nitrogen should be checked because kidney failure can present as depression, treatment with lithium can affect urinary clearances.
• Liver and lipid panel should be evaluated as many anti-psychotics medications cause changes in patients lipid profiles, resulting in dyslipidemia and liver damage.^[8]

• Wilson disease is a rare condition that is easily missed. Urine copper level testing may be performed to rule out Wilson disease, although not a routine screening test in bipolar disorder.^[9][10]
• Testing for human immunodeficiency virus (HIV) is important because AIDS causes changes in mental status, including dementia and depression.^[11]

• Alcohol abuse and illicit drugs can present as mania or depression. For example, amphetamines and cocaine can present as a mania like disorder, and barbiturate can present as a depression like disorder.^[12]

• Many patients with bipolar disorder, also have high rate of substance use disorders as a result it is associated with significant morbidity and mortality.^[12]