Mind Freeze - Bipolar Disorder

I have been diagnosed with bipolar II mainly because I got hypomanic on an SSRI about 10 years ago.  I have never been manic in my life.  On the contrary I tend to sleep 10 or more hours a night. My most distressing symptom is what I call spells.  These are periods of what I can only describe as a kind of mind freeze, as if one were suddenly being drawn into a dark tunnel.  Thought and action is severely dulled.  These spells would last about a day and then I would come out of it somewhat.  Does this sound like a symtom of bipolar disorder to you?  I am now taking lithium, zyprexa and paxil.  I seem to be stabilized on these medications, particularly the zyprexa.  I have not had that mind freeze on zyprexa although I have had it on lithium monotherapy

Dear Frank -- 
The diagnosis of "bipolar disorder" is so very complicated, most people and many mental health folks don't realize the number of variations that are possible.  Even with no more history to go into than what you have provided, we can see that whatever label we apply, the "bipolar" point of view leads to more effective treatments than the "unipolar" point of view.  So the label is getting rather unimportant at this point in your treatment, which should now be guided much more by your response to medications.  

For example, in more typical bipolar disorder we are thinking it might be best to taper someone off their antidepressant (very, very slowly and cautiously) and not have them stay on it (as we would have them stay on their mood stabilizer).  But in your case, you may well have a variant that does not get worse on an antidepressant (at least Paxil, as opposed to Prozac; the two are quite different in their tendency to provoke manic symptoms) when it is taken with a mood stabilizer (or in your case, two, as Zyprexa clearly has mood stabilizer effects).  

If your symptoms are fully controlled and you don't have side effect problems, there may be no point in trying to change your medications from here.  The label "bipolar II" might feel a bit too much to you, and I could understand that.  We recognize that the labels still matter a lot in terms of the stigma factors.  I guess my point would be that on reading your question, I think I hear some distress about the label but not too much about the treatment or remaining symptoms.  That's understandable.  Do you really have something that is like bipolar disorder?  Yes, on the basis of your description of the clearly cyclic -- but very short -- episodes of "brain freeze" and your better response particularly to Zyprexa, neither of which is very classic for more purely depressive illnesses (i.e. they don't recur so regularly, nor last such a short while, nor typically respond preferentially to Zyprexa as far as we know from our experience with that medication so far.).  

Dr. Phelps


Published March, 2001