Diagnosing Bipolar Disorder and the Effect of Antidepressants: A Naturalistic Study. [CME]
J Clin Psychiatry 2000;61:804-808
© Copyright 2014 Physicians Postgraduate Press, Inc.
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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.