Misdiagnosis of Bipolar II Disorder as Major Depressive Disorder

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Sir: Table 2 of the recent ACADEMIC HIGHLIGHTS on preventingrecurrent depression in patients with major depressive disorder(MDD)¹ reports that, despite maintenance treatment withantidepressants, recurrences may occur in 6% to 66% of patientswith MDD (vs. 23% to 100% of patients with MDD whoreceived placebo). This apparent high risk of recurrence inMDD has been attributed to placebo response, nonadherence, and tachyphylaxis (explained as an emotional blunting due toselective serotonin reuptake inhibitors, not as a true recurrence).1 Along with a possible loss of effect of antidepressantsin the long run,² the problem of the high proportion of bipolardepression, especially the depression of bipolar II disorder, misdiagnosedas MDD3-5 is not reported as a possible cause ofrecurrences.’ ‹