As more is known about the bipolar spectrum, there is more evidence to support that the use of antidepressants, without moodstabilizing medication, can not only precipitate manic, hypomanic, and mixed episodes, but may worsen the overall course of the illness. Because bipolar disorder is so often misdiagnosed as major depression, it’s common for people to be prescribed antidepressants without a mood stabilizer. If they are not closely monitored, it’s possible that a manic or mixed episode could develop.
And that brings us to the importance of the diagnosis: Since the risk of suicide is increased in mixed episodes, it’s easy to see how serious, and tragic, a missed diagnosis can be. Some experts speculate that the increase in suicidal behavior for some people taking antidepressants may relate to this phenomenon of triggering a mixed episode.