Abstract
The diagnosis of major depressive disorder(MDD)cannot be made in patients with major depressive episodes if they have shown hypomanic symptoms. However, hypomanic symptoms are often overlooked in daily clinical settings. Bipolar disorder(BD), especially bipolar II disorder(BDII), is liable to be misdiagnosed as MDD. Antidepressants may induce harmful events, such as manic switch, in patients with BD. Therefore, clinicians must carefully probe hypomanic episodes in patients with major depressive episodes. Moreover, the diagnosis of MDD should not be made lightly even if hypomanic episodes are not recognized, as patients with major depressive episodes may show hypomanic episodes during their clinical course. Early onset of major depressive episodes is regarded as one of the clinical signs in patients with BD rather than MDD. Many adolescents seek help with depressive symptoms in daily clinical settings. Clinicians should pay attention to unrecognized hypomanic symptoms. Patients may show one to four hypomanic symptoms during major depressive episodes. Such patients are regarded as having depressive mixed state, and that they should be diagnosed as having BDII rather than MDD.
