Some treated for depression may actually be bipolar

Recent studies suggest that the disorder is frequently missed or misdiagnosed as depression.

By Victoria Stagg Elliott, AMNews staff. Aug. 8, 2005.

When Sloan Manning, MD, a family physician from Greensboro, N.C., finished his residency in the late 1980s, selective serotonin reuptake inhibitors had just come on the market, making it possible for him and other primary care physicians to treat depressed patients within their own practices. Not all of his patients got better, however, and he started to investigate whether some had bipolar disorders rather than simple depression.

"The drugs were not working as often as I thought they should, and they were sometimes making people worse," he said.

Dr. Manning has written and lectured on this subject ever since. His efforts are backed by scientific literature saying that a certain percentage of patients diagnosed with depression may actually be bipolar. Most recently, a study published in the July-August Journal of the American Board of Family Practice found that, when screened for this mental illness, more than one in five patients on antidepressants tested positive.

"I'm very concerned that patients are being undertreated or treated improperly," said Robert Hirschfeld, MD, lead author on the paper and chair of psychiatry and behavioral sciences at the University of Texas Medical Branch in Galveston. "Treating bipolar patients with an antidepressant without a mood stabilizer is dangerous."

Also, a study in the Feb. 23 Journal of the American Medical Association found that about one in 10 of a representative sample of patients presenting to a clinic serving a low-income population also tested positive, although it was not reported how many of those were on antidepressants or with what condition they had been diagnosed.