Q: Doctor Questions Soft Bipolar
Dear Dr Phelps
Iīm a 39 years old psychian (general practicer. I hope you can give me
some advise. I am not treating myself, but here in Sweden we usually not
differential diagnosis such as soft bipolar disorder, or bipolar2
I am awere of your skillnes in affective disorders, so I make a trial to
see if you can respond, please...
I suffer from reccurant depression, since age of 20. I had cormorbid
illness, social phobia and some OCD symptoms. Fortunately alleviate this
I have tried lots of med: Different ssri. Zyban. Mirtazapin. Bromcriptin.
Pindolol. Buspirone. Mirapex. Not only as a monoterapi, but also in
I think that I have some soft bipolar tendency, because I always respond
very promt, rapid when I start with an antedepressant. When I started
Sertralin a couple years ago, I had a small,(not real) euphoric state
two days (hyperthymia). No different sleep pattern, occured. I week
later the the Sertralin started to poop- out, despite dosage increase,
and combo with Remeron. Could this patter be a sign of bipolar
My current med are:
I still donīt feel recovered. My current state is depression with an
strange pattern. In the evening, I could stared to cry, without any
cause. Is this pattern sign of bipolar disorders???
Before I started medication I had tre melancolic depression with
classical symptom, such as early weak and serve anxiety.
I realy want to wait with litium terapi, because of the long term side-
The best antedepressant so far are Venlaflaxine, and I feel good, with
higer dosage. The problem is that I have serve light sensetive and hot
facial flusches, from it. Do You know som med that can alliviate this
What do you think about replace Neurontin with Depakote. I Know that I
might have to decrease Lamictal.
Do you have any creative ideas??
Dear Dr. T' --
You've done a good job communicating your
questions and concerns. Not knowing how your system works, I
would have to start by encouraging you to work with a provider who knows
about bipolar and these medicines. I would agree with many of your
suspicions about the possibility of a "soft" bipolar on the
basis of your reported symptoms and experiences with medicines. I
would hope a mood stabilizer might offer benefit. Even lamotrigine
without an antidepressant is worth a try, arriving there by slowly
tapering your antidepressants -- but again, do this with someone who
knows about this diagnosis, if you possibly can. For example, you
must be extremely cautious about adding Depakote to lamotrigine as they
increase each other's levels dramatically and you could cause an
allergic reaction to the lamotrigine that is potentially quite
However, overall I would support your
suspicions. Except about lithium: if you watch the blood level and
avoid toxicity episodes, the long term risk is extremely low for most
people. I see it in the same range, as far as risk, as the rest of
the mood stabilizers.
Published April, 2001