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:
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.”
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As a counselor,to deal with my cliants, I found the information provided hereby, is very useful. I appreciate Dr. Candida Fink MD for the valuable observation and comments. It is useful for many doctors, students and even the caretakers of the patients. May God bless you and prosper you in your service for His glory and for the benefit of thousands of patients.
Yeah, that happened to me. I escaped a hospital emergency room (through the drop ceiling) and walked 26 miles. Holy shit, batman.
Hmm, this sounds familiar. Ok first all my doctor said was ‘OK, have you felt manic at all’ to which I replied ‘no’ (even if I had during a depressive episode who remembers EVER feeling happy?) the next problem I encounterd was that the prozac I was prescribed made me anxious, irritable, sleepless, not hungry etc. then when I complained he put me on another anti-depressant called amytriptaline, which made me all of the above, except I felt sleepy and dozey all the time. I took myself off of them and have since changed doctors, but I’m too scared to go back and ask for a proper diagnosis.
Looking back I realise that I was manic for much of my childhood, and this was occasionally seperated with a few days of crying and ditatchment. My parents always said I was the ‘exciting’ child, or that I had an ‘artistic temperment’. I had beleived this to be ADHD or similar, but now that my depressive/mild mania (now Im off the antidepressants it has calmed the mania a bit) I’m worried that I might be heading for a massive manic ep. How can I avoid or work round this? I’m about to start university and I have a small family and social groups to look after, but I really don’t want meds….
Ok, sorry for the rambling on, but I thought you people would probably be best to talk to, being wonderfully understanding.
Common scenario: patient treated for depression, becomes manic for the first time. Relabelled bipolar. What is the logical basis for this? A more scientific approach would question the role of antidepressants. Why “unmask” bipolar? Isn’t “create” more likely?
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