James Phelps, MD

James Phelps, MD

James Phelps, MD, is Director of the Mood Disorders Program at Samaritan Mental Health in Corvallis, Ore. He is the Bipolar Disorder Section Editor for Psychiatric Times. His Web site,, gathers no information on visitors and produces no income for him or others. He is the author of Why Am I Still Depressed? Recognizing and Managing the Ups and Downs of Bipolar II and Soft Bipolar Disorder (New York: McGraw-Hill; 2006), from which he receives royalties. Dr Phelps stopped accepting honoraria from pharmaceutical companies in 2008.

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After thorough examination and history-taking, bipolar II disorder was suspected in a 19-year-old college student. What psychiatric screening tools might be used to further confirm the diagnosis for this patient?

There is very little evidence for the efficacy of antidepressants in bipolar disorder, particularly for longer-term use. However, there are at least 9 alternatives to conventional antidepressants.

If your practice or your advocacy efforts place you anywhere near people encountering the mental health system for the first time, please have a look at this book.

With DSM-5, one more examination of bipolar diagnosis is warranted. After all, if a diagnosis is inaccurate, treatment efforts, however well-intentioned, may misfire.

Overdiagnosis of bipolar disorder is an increasing concern, particularly since a widely cited study that indicates a problem with overdiagnosis as well as with the much less publicized parallel finding of 30% underdiagnosis.

This essay begins an ongoing series on bipolar disorder focused on clinical utility.

Patients with bipolar disorder need a great deal of information about the illness. Without this education, adherence to your recommendations is uncertain; with it, outcomes will likely be better (and your job easier).

This essay is a brief update on an earlier Psychiatric Times article by Dr James Phelps. Several major studies have appeared since the publication of the original article, which shed further light on this issue.

When a new patient with depression enters your practice, you face a diagnostic dilemma. If you miss bipolar disorder (BD), and prescribe an antidepressant, you can do harm. But if you call a unipolar depression "bipolar," you may also do harm, because lithium, anticonvulsants, and atypical antipsychotics carry significant risk as both short- and long-term treatments. In addition, the label of "BD" currently carries much more stigma than the term "depression."

A look at how to use the spectrum concept to promote understanding and acceptance of bipolar II and soft bipolar diagnoses. In this article, you will find 5 tools for fostering what has been called “concordance” or, more simply, “buy-in.”


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