March 1, 2011

expert reaction to new research published in the British Journal of Psychiatry on unrecognised bipolar disorder in primary care patients with depression

The paper identified patients with bipolar disorder who were wrongly diagnosed with depression and given wrong treatments which made their symptoms worse.

Prof Richard Morriss, Professor of Psychiatry, University of Nottingham, said:

“It is possible that this is the first paper in UK primary care highlighting a serious problem of patients with bipolar disorder being diagnosed with depression and receiving treatment for depression that may potentially make their symptoms worse. However there are methodological problems with the paper and gaps in the evidence base on treatment of bipolar 2 disorder and bipolar spectrum disorder. Therefore the paper should be regarded as a paper justifying more research but not yet wholesale changes to clinical practice. There are several methodological limitations, namely the low response rate (only 19%), low number of people actually diagnosed with bipolar 1 and 2 disorder (17 participants), and the failure to include a personality disorder assessment. In people with depression who score highly on hypomania questionnaires there is a high prevalence of people with impulse control problems such as borderline personality disorder and intermittent explosive disorder who may superficially look like people with bipolar disorder. We also do not know the clinical significance of the findings because we do not know from RCTs if patients with bipolar 2 disorder and bipolar spectrum disorder would be helped more by using mood stabilisers or other treatment approaches for bipolar 1 disorder.”

Suzanne Hudson, Chief Executive of MDF The Biopolar Organisation, said:

“This finding confirms what we have been aware of for years. Again and again members tell us their experiences of being misdiagnosed as having depression often with devastating consequences. Very often they are prescribed antidepressants, which because of their underlying bipolar disorder, can then induce a manic episode.

“As Clare Dolman, Chair of Trustees & Research Psychologist based at Institute of Psychiatry explained the main reason for still frequent misdiagnosis appears to be lack of training given to GPs in mental health issues. As a national bipolar charity we are extremely concerned this is addressed as a priority especially as the new healthcare reforms will introduce more responsibilities for general practitioners.”

Unrecognised bipolar disorder in primary care patients with depression, Smith DJ et al, published in British Journal of Psychiatry at 00.01hrs, Tuesday 1 March 2011