Bipolar disorder can be and often is misdiagnosed as unipolar depression (see “52 Percent of Bipolar Patients Receiving Antidepressants as First-Line Treatment?“). This could be a very dangerous misdiagnosis, because many antidepressants used to treat depression can trigger (or “unmask”) mania, especially in people who really have Bipolar I. In other words, you could go into your doctor’s office feeling depressed and as a result of the anti-depressants experience a manic episode.

This is why it is so important for doctors to carefully screen patients whose only complaint is depression or anxiety before prescribing antidepressants. The doctor must first rule out any past occurrences of mania or hypomania or any family history of bipolar. Your doctor does this by examining the family history and asking a series of questions about any symptoms in the past that could suggest mania or hypomania, such as periods of time (lasting more than a few hours and being different than baseline) during which you experienced the following:

• Needing little to no sleep
• Euphoric or irritable mood
• Starting a million projects
• Feeling on top of the world or super-confident
• Doing things that got you into trouble, such as spending too much money, gambling away all your money, or driving recklessly

Patients don’t often report these symptoms, because they typically feel pretty “up” at these times – feeling euphoric and full of energy is not something that most people would associate with illness. To find out about a patient’s susceptibility to hypomania or mania, however, the doctor needs to ask these questions whenever interviewing a patient who is currently reporting symptoms that might normally lead the doctor to a diagnosis of unipolar depression.

A patient’s family history may also raise some red flags. If a family member in the past was diagnosed as having bipolar disorder or schizophrenia, for example, this could raise some suspicion that would cause your doctor to ask some additional diagnostic questions.

Some doctors perform a dangerous game of what I like to call “diagnosis by prescription.” A patient shows up depressed, so the doctor prescribes an antidepressant. The patient starts taking the antidepressant and, after a few weeks, begins experiencing symptoms of mania or hypomania. When the patient returns, the doctor then diagnoses the condition as bipolar disorder and prescribes a mood stabilizer.

Diagnosis by prescription is not an effective or useful way to diagnose or treat depression or bipolar disorder. Having a manic episode from antidepressants doesn’t necessarily mean that a person has bipolar disorder, although it can certainly lead a doctor to explore that possibility. Relying on a person’s response to a medication is no way to arrive at an accurate diagnosis.

Antidepressant-induced mania can occur even if a doctor does a thorough screening and an outstanding job of reviewing a patient’s history, so nobody can jump to the conclusion that a doctor acted improperly, if he or she does not recognize a particular patient’s genetic vulnerability to mania. Sometimes, the history provides little or no warning.

Sometimes people don’t experience a real manic episode until later in the illness – even in their 30’s or 40’s. The symptoms of mania may not have been present prior to that, so when they report to their doctors, their history may paint a diagnostic portrait only of someone who has been recurrently depressed for a long time – not someone who potentially has bipolar disorder.

Doctors generally follow the Hippocratic oath and “first do no harm.” More and more doctors are becoming aware that some antidepressants can unmask bipolar mania in patients who are predisposed to it and are more careful to do a thorough screening or refer a patient to a qualified psychiatrist before prescribing anything. If you are seeing your doctor for depression, just make sure the doctor also screens for any past signs or symptoms of mania or elevated moods that have lasted a long time. Otherwise, the medications you are given could create more problems than solutions.

Warning: This is not to say that if you are taking antidepressants, you should stop taking them. Depression is a serious problem that requires treatment, usually in the form of prescription medication. Treating depression in people with bipolar disorder is also essential, but is much more challenging.

For additional suggestions on how to team up with your doctor to establish a more accurate diagnosis and more useful treatment plan, check out the sample chapter from Bipolar Disorder For Dummies that we posted on our Bipolar Blog – Chapter 5, “Getting a Psychiatric Evaluation and Treatment Plan.”

Recently, the NIMH (National Institute of Mental Health) distributed a press release entitled “Largest Study of Its Kind Implicates Gene Abnormalities in Bipolar Disorder.” According to the press release, this “largest genetic analysis of its kind to date for bipolar disorder has implicated machinery involved in the balance of sodium and calcium in brain cells.” As the press release points out, no single gene has been identified as the “bipolar gene.” Researchers generally agree that multiple genes contribute to make an individual more susceptible to the eventual onset of bipolar disorder.

For more about bipolar disorder genetics and heredity, check out Dr. Fink’s two-part series – “Bipolar Disorder & Heredity: The Genetic Link.”

According to the results of a recent survey conducted by Decision Resources (”one of the world’s leading research and advisory firms focusing on pharmaceutical and healthcare issues”), 52.3 percent of newly diagnosed bipolar disorder patients are prescribed antidepressant drugs first line. (See the press release “Astonishing 52 Percent of Newly Diagnosed Bipolar Disorder Patients Receive Antidepressant Drugs in First-Line Treatment.”) Read the rest of this article »

Larry and Linda Drain who have formed a local chapter of DBSA (Depression and Bipolar Support Alliance) in Blount County, Tennessee. The group’s mission is to provide information and support for people with bipolar disorder and their loved ones and facilitate connections among people in the bipolar community. As Larry has said, “The weight is less heavy when it’s shared.” Read the rest of this article »

With this post, we continue our biweekly series on medications used to treat bipolar disorder and related symptoms. This week, we focus the spotlight on Lamictal (lamotrigine) – an anti-seizure medication that has been found useful in treating bipolar disorder. Following are some of the primary benefits Lamictal offers: Read the rest of this article »

Many people with bipolar stop taking their medications at some point in their treatment. This is a reality that patients, doctors, and family members often wrestle with. But it’s important to understand some of the possible reasons why. Understanding that there are often compelling factors in someone’s decision to stop their meds can help loved ones approach the problem without judgment. And for people with bipolar disorder it is critical to honestly evaluate why they want to stop taking their medication, because then they can tackle these issues directly and without judging themselves. Read the rest of this article »

Whenever we blog about medications used to treat bipolar disorder, invariably someone writes in boasting about their success at being medication free or sounding the alarm about the evils of psychiatric medications. If someone posts a comment about how medications have helped them, someone usually replies by saying something like, “I’m happy for you, but just wait a few years when you don’t have a functioning kidney.” Read the rest of this article »

Syndicated from the Bipolar Blog

When you begin seeing a psychiatrist (or any physician who manages your bipolar medication), you may begin to feel like a guinea pig. Your doctor tries one medication after another to see which one works and which one doesn’t, which one produces the least annoying side effects, and which medications seem to get along best with one another when you’re taking multiple medications. You may begin to wonder whether you are the first person on the planet who’s been diagnosed with bipolar disorder. Shouldn’t the medical community know by now what works and what doesn’t?! Read the rest of this article »

With this post, we continue our biweekly series on medications used to bipolar disorder and related symptoms. We launched the series with a post on lithium – the standard bearer for the so-called mood stabilizers . Read the rest of this article »

In Part I of this two-part series, we examined the role that genetics likely plays in the onset of bipolar disorder and learned that genetics contributes up to 80%, with environmental factors contributing about 20% or more. (This means that if someone has bipolar disorder, the cause of it is 75-80% due to genetics. It does not mean an individual in a family with a history of bipolar has a 75-80% chance of developing it. See Part I for statistics on the inheritability of bipolar.)

It appears that for most people there needs to be some environmental factors that “turn on” the genes responsible for one’s vulnerability to bipolar disorder. Many of these environmental triggers may occur early in life and may include things such as: Read the rest of this article »