When Failure to Diagnose Bipolar Disorder Leads to Tragic Outcomes

In psychiatric malpractice cases, proper diagnosis and medication management are critical. Failure to recognize bipolar disorder, particularly when prescribing antidepressants, can have serious and sometimes fatal consequences.

At Velaris Consulting Group, we were asked to review a psychiatric case involving concerns of below-standard care and improper medication management.

Case Summary

A 39-year-old man presented to a medical clinic on May 2 for treatment of depression. During the visit, he completed a mental health questionnaire, indicating:

• Multiple positive responses for depressive symptoms

• Positive indicators consistent with bipolar disorder

The questionnaire also contained an unsigned handwritten note stating a prior history of bipolar disorder.

Despite these findings:

• The patient was diagnosed with depression only

• He was prescribed fluoxetine (Prozac) 20 mg daily

• No mood stabilizer was initiated

• No documented evaluation of manic symptoms occurred

The patient was instructed to follow up by phone in two weeks and return in four to six weeks.

He died by suicide eight days later, on May 13.

Medical Negligence Considerations

The central malpractice question was whether the treating clinician met the community standard of care.

Based on our review of the medical records, it was our opinion that:

• Bipolar disorder should have been diagnosed or strongly considered

• The questionnaire responses warranted further evaluation for manic symptoms

• The documentation did not reflect an appropriate diagnostic assessment

Importantly, the questionnaire appears not to have been reviewed during the visit, and no follow-up questions regarding bipolar history were documented.

Antidepressants and Bipolar Disorder: Standard of Care

It is widely recognized in psychiatric practice that antidepressants should not be prescribed to patients with bipolar disorder without mood-stabilizing coverage.

Medical literature and clinical guidelines warn that antidepressants alone may:

• Trigger manic or rapid cycling episodes

• Worsen mood instability

• Increase suicide risk

Mood stabilizers such as lithium, valproic acid, or atypical antipsychotics are commonly required before or alongside antidepressants. Some recent studies even question whether antidepressants should be used at all in bipolar patients.

Causation and Outcome

One of the most serious risks of improper antidepressant use in bipolar disorder is rapid cycling between depression and mania. During depressive episodes, suicidal ideation is a known and significant risk.

It was our medical opinion that:

• The failure to recognize bipolar disorder

• Combined with antidepressant monotherapy

• Likely contributed to the patient’s mental deterioration

Conclusion

Based on the medical record, clinical standards, and psychiatric literature, it was our professional opinion that the care provided fell below the applicable standard of care.

This case highlights how diagnostic oversight and medication mismanagement can form the basis of a psychiatric malpractice claim.

How Velaris Consulting Group Assists Medical Negligence Attorneys

Velaris Consulting Group provides physician-led medical analysis to support attorneys handling:

• Psychiatric malpractice

• Failure to diagnose cases

• Improper medication management

• Suicide-related medical negligence claims

Our services include:

• Medical record review and summary reports

• Standard-of-care analysis

• Medical causation opinions

• Medical literature research

• Expert witness referral

• Deposition and trial preparation support

We help attorneys identify case strengths, weaknesses, and medical defensibility early in litigation.

Contact Velaris Consulting Group

To discuss a potential medical negligence case or request a fee schedule.