Is bipolar disorder still underdiagnosed? Are antidepressants overutilized?

Area of Science:

• Psychiatry
• Mood Disorders
• Diagnostic Accuracy

Background:

• Previous research indicates potential underdiagnosis of bipolar disorder.
• Concerns exist regarding the overutilization of antidepressants in bipolar disorder treatment.

Purpose of the Study:

• To assess the diagnostic accuracy of bipolar disorder in a referred mood disorder population.
• To evaluate treatment patterns and outcomes, including antidepressant use and alternative therapies.

Main Methods:

• Systematic interviews and chart reviews were conducted on 48 consecutively admitted patients with DSM-IV bipolar disorder or schizoaffective disorder, bipolar type.
• Patients received treatment based on systematic structured interview diagnoses.
• Diagnosis confirmation and treatment changes were documented.

Main Results:

• Forty percent (19/48) of patients were identified with previously undiagnosed bipolar disorder, all initially diagnosed with unipolar major depressive disorder.
• A significant delay (7.5+/-9.8 years) occurred before the correct bipolar diagnosis was established.
• Antidepressant use was high (38%) on admission but reduced during treatment, with acceptable response rates.
• Adjunctive risperidone demonstrated effectiveness as a treatment alternative.

Conclusions:

• Systematic application of diagnostic criteria identified a high rate of previously undiagnosed bipolar disorder.
• Antidepressant overutilization is suggested, with risperidone emerging as a viable adjunctive therapy.
• Prospective diagnoses and retrospective treatment response assessment highlight the need for accurate initial diagnosis in mood disorder patients.