Diagnosing bipolar disorder and the effect of antidepressants: a naturalistic study

J Clin Psychiatry. 2000 Oct;61(10):804-8; quiz 809. doi: 10.4088/jcp.v61n1013.


Objectives: To determine if bipolar disorder is accurately diagnosed in clinical practice and to assess the effects of antidepressants on the course of bipolar illness.

Method: Charts of outpatients with affective disorder diagnoses seen in an outpatient clinic during 1 year (N = 85 with bipolar or unipolar disorders) were reviewed. Past diagnostic and treatment information was obtained by patient report and systematic psychiatric history. Bipolar diagnosis was based on DSM-IV criteria using a SCID-based interview.

Results: Bipolar disorder was found to be misdiagnosed as unipolar depression in 37% of patients who first see a mental health professional after their first manic/hypomanic episode. Antidepressants were used earlier and more frequently than mood stabilizers, and 23% of this unselected sample experienced a new or worsening rapid-cycling course attributable to antidepressant use.

Conclusion: These results suggest that bipolar disorder tends be misdiagnosed as unipolar major depressive disorder and that antidepressants seem to be associated with a worsened course of bipolar illness. However, this naturalistic trial was uncontrolled, and more controlled research is required to confirm or refute these findings.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age of Onset
  • Ambulatory Care
  • Antidepressive Agents / therapeutic use*
  • Bipolar Disorder / diagnosis*
  • Bipolar Disorder / drug therapy*
  • Depressive Disorder / diagnosis
  • Depressive Disorder / drug therapy
  • Diagnosis, Differential
  • Diagnostic Errors
  • Female
  • Humans
  • Male
  • Medical Records
  • Psychiatric Status Rating Scales / statistics & numerical data
  • Treatment Outcome


  • Antidepressive Agents