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Antidepressants Risky for Bipolar II?

Researcher Says Doctors Often Give Wrong Treatment for a Type of Bipolar Disorder
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WebMD Health News
Reviewed by Louise Chang, MD

March 15, 2007 -- There is widespread concern that antidepressants may increase suicide risk, but an Italian psychiatric disorders expert says this may only be true when the drugs are used incorrectly.

In an essay appearing March 17 in The Lancet, Franco Benazzi, MD, PhD, writes about a common but poorly recognized form of bipolar disorder, called bipolar disorder II.

Because the disorder is so often misdiagnosed, patients are often wrongly treated with antidepressants alone, which can make the problem worse, the professor of psychiatry tells WebMD.

"These patients need to be on mood-stabilizing drugs, and if depression persists an antidepressant can be added," Benazzi says. "Treating these patients with antidepressants alone can actually increase the manic episodes and worsen the disorder."

What Is Bipolar Disorder II?

Once known as manic depression, bipolar disorder is characterized by dramatic mood swings in which patients experience extreme highs and extreme lows. Bipolar disorder II is considered a less severe form of the disease, with mild to moderate levels of mania known as hypomania.

Patients with bipolar I may have psychotic episodes, but hallucinations and delusions do not occur with bipolar II.

Because mood swings are less obvious than with bipolar I, diagnosing bipolar disorder II remains a challenge. Patients often suffer from depression as well and that is why so many are treated only with antidepressants.

"The depression is recognized, but the bipolar disorder is not," Benazzi says.

The problem may be especially common in children and adolescents.

"Misdiagnosis of bipolar disorder as attention deficit hyperactivity disorder [ADHD] and major depressive disorder is common, leading to the use of stimulants and antidepressants, which might worsen the course instead of mood-stabilizing agents," he notes.

Benazzi writes that patients who show symptoms of what appears to be depression should be evaluated for manic or hypomanic symptoms. If bipolar disorder is diagnosed, treatment should include mood-stabilizing drugs like lithium, with or without antidepressants.

The widespread use of antidepressants alone in patients with mixed depression may explain the reported increase in suicides among patients on these drugs.

"The suicidality sometimes related to antidepressants is probably not caused by the [drugs], but by clinicians using only antidepressants to treat mixed depression," Benazzi concludes.

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