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Study: Bipolar Disorder Commonly Misdiagnosed
Friday , March 16, 2007

There is widespread concern that antidepressants may increase suicide risk, but an Italian psychiatric disorders expert says this may only be true when the drugs are used incorrectly.

In an essay appearing March 17 in The Lancet, Franco Benazzi, MD, PhD, writes about a common but poorly recognized form of bipolar disorder, called bipolar disorder II.

Because the disorder is so often misdiagnosed, patients are often wrongly treated with antidepressants alone, which can make the problem worse, the professor of psychiatry tells WebMD.

"These patients need to be on mood-stabilizing drugs, and if depression persists an antidepressant can be added," Benazzi says. "Treating these patients with antidepressants alone can actually increase the manic episodes and worsen the disorder."

What Are the Symptoms of Bipolar Disorder?

What Is Bipolar Disorder II?

Once known as manic depression, bipolar disorder is characterized by dramatic mood swings in which patients experience extreme highs and extreme lows. Bipolar disorder II is considered a less severe form of the disease, with mild to moderate levels of mania known as hypomania.

Patients with bipolar I may have psychotic episodes, but hallucinations and delusions do not occur with bipolar II.

Because mood swings are less obvious than with bipolar I, diagnosing bipolar disorder II remains a challenge. Patients often suffer from depression as well and that is why so many are treated only with antidepressants.

"The depression is recognized, but the bipolar disorder is not," Benazzi says.

The problem may be especially common in children and adolescents.

"Misdiagnosis of bipolar disorder as attention deficit hyperactivity disorder [ADHD] and major depressive disorder is common, leading to the use of stimulants and antidepressants, which might worsen the course instead of mood-stabilizing agents," he notes.

Benazzi writes that patients who show symptoms of what appears to be depression should be evaluated for manic or hypomanic symptoms. If bipolar disorder is diagnosed, treatment should include mood-stabilizing drugs like lithium, with or without antidepressants.

The widespread use of antidepressants alone in patients with mixed depression may explain the reported increase in suicides among patients on these drugs.

"The suicidality sometimes related to antidepressants is probably not caused by the [drugs], but by clinicians using only antidepressants to treat mixed depression," Benazzi concludes.

Is It ADHD or Bipolar Disorder?

More Study Needed

Researcher Rif S. El-Mallakh, MD, of the University of Louisville School of Medicine, says clinicians have gotten better in recent years at identifying bipolar disorder II. But he adds that too many patients are still being improperly treated.

El-Mallakh, who is an associate professor of psychiatry, tells WebMD that in addition to increasing the frequency of manic or hypomanic episodes, antidepressants can worsen depression and increase the likelihood of future depression.

When bipolar patients experience four or more manic or hypomanic or depression episodes within a year it is known as rapid cycling.

Prior to the introduction of antidepressants, rapid cycling was quite rare in bipolar disorder, occurring in just 2% to 3% of patients, El-Mallakh says. These days, he adds, 20% to 25% of patients experience rapid cycling.

The researchers agree that more research on bipolar disorder II and the related spectrum of disorders is needed.

Benazzi points to studies suggesting that on average patients with bipolar disorders are misdiagnosed for eight to 10 years before their disease is correctly identified.

"Depression tends to get worse as the disorder progresses, especially if patients are taking the wrong drugs for many years," he says


Re: Study: Bipolar Disorder Commonly Misdiagnosed

I'm not Bipolar II, but I am so uncommonly depressed at this moment I'm considering calling in sick, even though it's the end of the month and I need the paycheck. I've been depressed since sometime Tuesday, with brief rest bits over morning coffee before I realize it's going to be another glum day. I'm about to call my therapist in another county, but she can't always talk. It will take time before everything is transferred over here. I called my old Kaiser therapist too, but he hasn't called back yet. No one will talk to me, and I feel a little too alone. I tried going outside but it didn't help and I just wanted to come back in. So I did.

I just saw there was an "ID Restricted" voice mail message -- was not my ex-therapist, but it was a slightly positive call about severing another burdensome relationship, so I'm slightly uplifted. Maybe I can shower now, and possibly even get outside and to work. I've still got an hour and a half before I absolutely have to be out the door.


Re: Study: Bipolar Disorder Commonly Misdiagnosed

You might find that going to work will actually help relieve some of the depression. You'll have other things to occupy your mind, and may get positive reinforcements to help you to bring yourself out of the doldrums.

Good luck! :hug:


Re: Study: Bipolar Disorder Commonly Misdiagnosed

Thanks for your posts, ThatLady. I'm just now receiving all three of them, and I commented on the one in "Can't Figure Things Out" at some length. Thank you.

Both my therapists returned my calls. I was able to talk with my present therapist for about a half hour, and we decided that this particular day holds nothing all that threatening to me; in fact, most people would be jealous over how easy a day I've got for a $70 paycheck. (By the way, in my response to your post in "Can't Figure Things Out," I temporarily forgot about the paycheck, and assumed I would still be broke for the rest of the month. I was upset over the thought of having to buy something new, and I wasn't thinking clearly. Still, I don't want to spend $20 or $30 on a new mouse out of a $70 paycheck that ought to have bought food till Monday.)

Also, she reminded me that "feelings aren't facts," and if I scan the events of the past couple months, a lot of good things have happened, and *are* happening. If I focus on the good things, and believe that I can expand upon them to create even better things, it will go a long way toward lifting me out of the depths.

As soon as we got off the phone, I felt myself sinking again; however, I did find the motivation to shower, change, and get on the bus and train. A friend of mine from the East Coast called, and I got into her stuff for a while, and that was helpful. Now I'm at a Starbucks near the voice studio, and the director (my boss) is going to pick me up in about ten minutes.

Thank you for all your input.
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