Is Your Depressed Patient Bipolar?

Neil S. Kaye, MD, DFAPA


J Am Board Fam Med. 2005;18(4):271-281. 

In This Article

Consequences of Misdiagnosis

Missing the diagnosis of a bipolar disorder could have serious and even occasionally fatal consequences for a person with the illness. Lifetime risk of suicide attempts among patients with bipolar disorders ranges from 25% to 50%,[32] and estimates of completed suicide in persons with a bipolar disorder diagnosis are between 10% and 15%.[7] Epidemiologic data also reveal that suicide attempts occur 30 times more frequently during depressive episodes than during manic or hypomanic states.[4]

Misdiagnosis and inappropriate treatment can also prolong suffering and contribute to worsening occupational, family, and social problems. The situation is particularly concerning because the use of antidepressants in bipolar depression, especially without the concomitant use of a mood stabilizer, may actually worsen the course of the disease. Antidepressants have been shown to contribute to rapid cycling,[28,33]in which patients experience more mood swings than are normally seen, with at least 4 episodes of mania/hypomania and/or depression over a 1 year period. Rapid-cycling patients experience more episodes of illness, with progressively shorter periods of wellness and a diminished response to medication.[34] At the present time, it is unclear whether the use of mood stabilizers in conjunction with an antidepressant protects against the development of rapid cycling.


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