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J Clin Psychiatry. 2000 Oct;61(10):804-8; quiz 809.

Diagnosing bipolar disorder and the effect of antidepressants: a naturalistic study.

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1
Cambridge Hospital, Department of Psychiatry, Harvard Medical School, Mass, USA.

Abstract

OBJECTIVES:

To determine if bipolar disorder is accurately diagnosed in clinical practice and to assess the effects of antidepressants on the course of bipolar illness.

METHOD:

Charts of outpatients with affective disorder diagnoses seen in an outpatient clinic during 1 year (N = 85 with bipolar or unipolar disorders) were reviewed. Past diagnostic and treatment information was obtained by patient report and systematic psychiatric history. Bipolar diagnosis was based on DSM-IV criteria using a SCID-based interview.

RESULTS:

Bipolar disorder was found to be misdiagnosed as unipolar depression in 37% of patients who first see a mental health professional after their first manic/hypomanic episode. Antidepressants were used earlier and more frequently than mood stabilizers, and 23% of this unselected sample experienced a new or worsening rapid-cycling course attributable to antidepressant use.

CONCLUSION:

These results suggest that bipolar disorder tends be misdiagnosed as unipolar major depressive disorder and that antidepressants seem to be associated with a worsened course of bipolar illness. However, this naturalistic trial was uncontrolled, and more controlled research is required to confirm or refute these findings.

PMID:
11078046
[Indexed for MEDLINE]

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