Bipolar Disorder - or Cocaine?
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"Bipolar" -- or cocaine

Q: My significant other has recently been diagnosed bipolar. She is currently in a drug treatment center at Glenbeigh Hospital. From what I have researched im finding that many of the actions or reactions of a bipolar person are very similar to that of a person with a cocaine habit should we get another opinion of this diagnosis. She has been placed on an antidepressant and mood stabilizer. Im wondering if they are truely warranted. She will be coming home soon and will have to follow up with a local doctor, where or whom i do not know as of yet. Please advise....

Dear Violet --
You're right: if you know she's using cocaine, she can't be reliably diagnosed as "bipolar".  The two can look basically identical: highs, lows, racing thoughts.  On the other hand, using cocaine doesn't mean she doesn't have bipolar either.  She can have both problems; in fact that's pretty common.  But her "prognosis" is radically different dependent on which explanation is used: no cocaine, no "cycling" -- unless she's got the bipolar piece too, in which case she'll continue to cycle but may have great difficulty stopping her drug use.  It gets pretty tricky sometimes trying to tease these two apart.   You'll have to decide if you are going to tell her doc' about the cocaine use, with or without her permission -- also tricky.  But her doc's treatment could be pretty "off" if she/he doesn't know about the cocaine, as you point out.  Sorry, can't really advise beyond that.

Dr. Phelps

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