Bipolar and fibromyalgia
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Bipolar and fibromyalgia?

Q: Dear Dr. Phelps,

There seem to be more and more women with Bipolar Disorder who are being also diagnosed with Fibromyalgia.  Do you think there is a connection between the two?

Colleen

Dear Colleen

I've never seen a word in the literature about this, but I've sure seen it in practice -- over and over. So, to
answer their question: yes, I see the two show up together. In fact, in virtually all the "fibromyalgia" patients I've seen, there is mood stuff too. Of course, I wouldn't be likely to see FM patients who had no mood symptoms at all! But my rheumatologist friend says he sees the overlap too. But the important point to me is that the mood symptoms are much more likely, in my view, to have "bipolar" characteristics (as opposed to unipolar): profound sleep disturbance, cyclic recurrence, irritability and decreased concentration even when little "depression" is present. Perhaps most salient: the FM symptoms seem to directly cycle with sleep, almost as though in these women -- as they are nearly all women -- the pain symptoms are just another "bipolar" symptom. i.e. the pain *cycles* along with the rest of what we might typically regard as mood symptoms. Think about it: what if "chronic fatigue syndrome", which also co-occurs with FM and bipolar, was in some people just the depressed phase of "bipolar", with it's characteristic profound lethargy and fatigue, without obvious depression? As most patients know, the "mood dial" and the "energy dial" don't always turn the same way at the same time; they're relatively independent, at least in some people. Finally, why is that there is such a predominance of women with FM? This is an obvious and crucial question. I used to think it was because sexual abuse is so unfortunately common in women. But I've seen women with no such history, nor any clear reason to suspect some "repressed memory" either. I'm working on a "hormones and mood" website where I'll try to present current research that relates to this topic. 

Dr Phelps


Published September, 2000
 

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