Bipolar III?

Q: what is "type three" case of bi-polar?; Dr said it is rare

Dear Sue --
Bipolar III is not in the "official rule book", but is used by mood experts to refer to hypomania that emerges only when a patient is given an antidepressant.  In my experience this is not at all rare, and prompts an examination of the patient's previous mood experiences to see if there is a subtle Bipolar II in her/his history.  If it's subtle enough, it may not need treatment with mood stabilizers.  And since we usually use the same threshold of severity of symptoms to: a) decide that a person merits a "diagnosis", and b) decide that she merits treatment -- this means that someone who does not merit treatment should not get the label Bipolar II (since these labels carry a lot of unfortunate weight, in a variety of ways). 

The point of all this is that some doc's might call such a person -- who has some symptom history perhaps, but doesn't merit a diagnosis -- Bipolar III, if she gets mildly hypomanic on an antidepressant. 

And the most important point: this person should watch out about taking an antidepressant alone.  Wellbutrin seems to be the best tolerated antidepressant in this situation, amongst the routinely used antidepressants (i.e. least likely to precipitate hypomania). 

Dr. Phelps


Published February, 2001