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Misdiagnosis or Missed Diagnosis: Antidepressants + Bipolar Disorder (could) = Mania

Misdiagnosis or Missed Diagnosis: Antidepressants + Bipolar Disorder (could) = Mania

We began a two-part series yesterday on the dangers of misdiagnosis and missed diagnosis. I used a vignette featuring a patient with whom I worked who I believe was misdiagnosed – resulting in traumatic psychiatric crisis evaluations (one involving a trip to the E.R. by ambulance) and a brutal meds regimen.

Today I’d like us to discuss the perils of misdiagnosing bipolar depression as unipolar. By the way, here’s an article I wrote on the difference between unipolar and bipolar depression.

As you may know, the use of antidepressants by those enduring bipolar disorder is very dicey business. And the controversy rages on, as most psychiatrists have seen some great outcomes; however, there are those who simply won’t prescribe them.

Here are the areas of greatest concern…

  • Switching from a depressive episode into one of hypomania or mania
  • Mood Destabilization on a long-term basis
  • Rapid Cycling
  • Kindling – for those of you not familiar with this fascinating phenomenon, here’s an article I wrote that’ll dial you in

Given the nasty potentialities, can you see how important it is to ensure a depressive presentation is correctly assessed, diagnosed, and medicated?

So how can we be doing all we can to prevent such misfortune?

  • Make sure the professional who’s doing the assessing, diagnosing, and prescribing knows what the heck they’re doing. What was involved in your selection process? Do you need to make a change?
  • If you’re relying upon your PCP, maybe it’s time to work with a psychiatrist.
  • Make sure you’ve given an accurate account of your symptom and treatment history. What’s worked? What hasn’t? Make some notes before reporting for you appointment.
  • Make sure you keep your psychiatrist informed as to your response to your medication(s). Keep a journal!
  • Do your own research – the Internet, books, forums, blogs, talking with others enduring bipolar disorder. What’s working out there? What isn’t? But you have to make sure the results that have caught your attention have occurred in those with case particulars very much like yours.
  • Never hesitate to share your discoveries with your psychiatrist, even proposing diagnoses and treatment regimens (Oh my – did I really suggest that?).

Incidentally, this applies to any emotional, mental, or physical situation.

And there’s the series, chipur readers. We all learn and grow when we read your comments. How ’bout taking the time to jot down some feelings and thoughts?

reference: Dr. Jim Phelps,


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