Misdiagnosis of bipolar depression in primary care practices.

Misdiagnosis of bipolar disorder is too frequent in primary care practices. Early diagnosis of the disease is crucial for appropriate treatment and optimal outcomes, yet patients may go years without a proper diagnosis. Misdiagnosis of unipolar depression may occur when patients with depressive symptomatology report no manic or hypomanic episodes. Furthermore, bipolar disease may begin as depression and develop into bipolar disorder. Primary care physicians can watch for several red flags in patients with depressive episodes, such as poor functioning in social and work arenas, risky behaviors, and legal issues. Other warning signs include a family history of bipolar disorder, psychosis at the index depressive episode, young age at onset of depression, and either antidepressant resistance or antidepressant-induced mania or hypomania. Correct and timely recognition of bipolar disorder by primary care physicians can provide long-lasting benefits for the patient.