From the Guidelines
Bipolar disorder laboratory workup should include a comprehensive panel of tests, including complete blood count, comprehensive metabolic panel, thyroid function tests, fasting glucose, lipid profile, and urinalysis, as well as targeted testing for specific medications, such as lithium, valproate, and atypical antipsychotics, to establish baseline values and monitor treatment safety 1.
Initial Testing
Initial laboratory testing for bipolar disorder should include:
- Complete blood count (CBC) to rule out underlying medical conditions
- Comprehensive metabolic panel (CMP) to assess electrolyte balances and renal function
- Thyroid function tests (TSH, free T4) to exclude thyroid dysfunction
- Fasting glucose and lipid profile to evaluate metabolic status
- Urinalysis to assess renal function and detect potential abnormalities
Targeted Testing for Medications
Before initiating specific medications, targeted testing is necessary:
- Lithium requires baseline renal function tests (BUN, creatinine) and electrolytes, as well as regular monitoring of lithium levels, renal and thyroid function, and urinalyses every 3-6 months 1
- Valproate needs liver function tests (AST, ALT) and a complete blood count, with periodic monitoring of serum drug levels, hepatic and hematological indices every 3-6 months 1
- Atypical antipsychotics warrant baseline glucose, lipids, and possibly prolactin levels, with regular monitoring of body mass index, waist circumference, blood pressure, fasting glucose, and lipids 1
Additional Testing
Additional testing may include:
- Vitamin B12 and folate levels to assess potential deficiencies that can affect mood regulation
- Urine drug screen to identify substance use that may contribute to or mimic mood symptoms
- Electrocardiogram (ECG) before starting medications with cardiac effects, such as certain atypical antipsychotics 1
From the Research
Lab Workup for Bipolar Disorder
The lab workup for bipolar disorder typically involves a combination of tests to rule out other conditions and to monitor the patient's physical health. Some of the key tests include:
- Complete blood count (CBC) to check for any underlying infections or inflammation 2
- Thyroid function tests to check for thyroid dysfunction, which is common in patients with bipolar disorder 3, 4
- Electrolyte panel to check for any imbalances in electrolyte levels
- Liver function tests to check for any liver damage or dysfunction
- Renal function tests to check for any kidney damage or dysfunction
- Fasting glucose and lipid profile to check for any metabolic disorders, such as diabetes or dyslipidemia 3, 5
- Inflammatory markers, such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), to check for any underlying inflammation 2
Monitoring for Metabolic Syndrome
Patients with bipolar disorder are at increased risk for metabolic syndrome, which is a cluster of conditions that increase the risk for heart disease and stroke. Monitoring for metabolic syndrome typically involves:
- Measuring body mass index (BMI) and waist circumference 5
- Checking blood pressure and lipid profiles 3, 5
- Monitoring glucose levels and checking for diabetes 3, 5
- Checking for other signs of metabolic syndrome, such as high blood pressure and elevated triglycerides
Thyroid Function Tests
Thyroid function tests are important in patients with bipolar disorder, as thyroid dysfunction is common in this population. Some of the key thyroid function tests include:
- Thyroid-stimulating hormone (TSH) levels 4
- Free thyroxine (FT4) levels 4
- Free triiodothyronine (FT3) levels 4
- Thyroxine (T4) levels 4
- Triiodothyronine (T3) levels 4
Inflammatory Markers
Inflammatory markers, such as CRP and ESR, can be elevated in patients with bipolar disorder, particularly during episodes of mania or depression. Monitoring inflammatory markers can help to identify patients who are at increased risk for cardiovascular disease or other complications 2.