Q:  Bipolar Disorder in Older People (mom)

Our family has a long history of mild clinical depression (me, my sister, my brothers, maternal aunts, maternal uncles, maternal grandmother, maternal great grandfather). Recently, after 50+ years of living with untreated depression, my mother started taking Effexor. On a recent extended visit to my home, I noticed her propensity to talk nonstop, to become highly agitated at inconsequential things, extreme irritation countered with inappropriate joke telling and laughter. Also, I noticed that she was spending a lot more money than usual. Is it possible that she is experiencing hypomania or mixed mood disorder? If so, what treatment strategy would you recommend for a patient strenuously opposed to seeing a psychiatrist?

Dear Barbara -- 
Good work figuring out this potential explanation.  It would be hard to explain her behavior, if this is truly quite dramatic and out of character (as opposed to some newfound joy in life and decision to change her previously rather cautious spending, and stress of a new situation causing her irritability), in some other way.  

Strategies: call the doc' who's prescribing Effexor and describe the behaviors you see (she/he can take information from you without a "release of information" signed by mother); if necessary, you could point out that you know that antidepressants can cause hypomania and that at minimum, dose reduction has been proposed as a strategy for coping with this (e.g. cite this reference

Megna JL, Devitt PJ  Treatment of bipolar depression with twice-weekly fluoxetine: management of antidepressant-induced mania.  Ann Pharmacother 2001 Jan;35(1):45-7

CONCLUSIONS: Manic switching is always a concern when treating a bipolar depressed patient. Utilization of a low-dose antidepressant drug regimen may be a clinically prudent approach in such an individual.           )

Beyond this one would have to consider mood stabilizers (or sometimes in folks over 60 little tiny doses of Risperidone have substantial antidepressant effects, in my experience; e.g. 0.25 or 0.5 mg.).  For that, either the doc' or your mother is going to have to "buy in" to the diagnosis.  You could use my website as part of the sell for her doc', if it finally comes to that (see the "dear doctor letter").  

Published March, 2001