Is bipolar disorder still underdiagnosed? Are antidepressants overutilized?

Background: Previous studies have suggested that bipolar disorder may be un derdiagnosed, and that antidepressants may be over-utilized in its treatmen t, Methods: Consecutively admitted patients (n = 48) diagnosed with DSM-IV bipolar disorder, type I, (n = 44) or schizoaffective disorder, bipolar typ e, (n = 4) were interviewed systematically and their charts were reviewed t o confirm diagnosis before admission. They were then treated according to s ystematic structured interview diagnoses. These data reflect the changes in diagnoses and treatment. Results: 40% (19/48) were identified with previou sly undiagnosed bipolar disorder, all previously diagnosed with unipolar ma jor depressive disorder. A period of 7.5+/-9.8 years elapsed in this group before bipolar diagnosis was made. Antidepressant use was high on admission (38%) and was reduced with acceptable treatment response rates. The adjunc tive use of risperidone appeared to be a good treatment alternative. Limita tions: While diagnoses were made prospectively, treatment response was asse ssed retrospectively, and was based on non-randomized, naturalistic therapy . Conclusions: Systematic application of DSM-IV criteria identified previou sly undiagnosed bipolar disorder in 40% of a referred population of patient s with mood disorders, all previously misdiagnosed as unipolar major depres sive disorder. Antidepressants appeared overutilized and risperidone was an effective alternative adjunctive therapy agent, (C) 1999 Elsevier Science B.V. All rights reserved.