My Diagnosis is Disputed
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Q:  My Diagnosis is Disputed

Dear Dr Phelps,

My diagnosis is disputed between my doctors! One is adamant I'm bipolar, the other that I'm suffering long term depression from emotional probs. I don't deny I have emotional probs but for a week or two I feel quite normal and any problems seem no worse than anyone else's. Then I start to sleep badly, have dry mouth, tremble and feel very tired. On about day 3, I start to feel gloomy and introspective and the misery increases over a few days until I can hardly speak,cry endlessly, want to die, hate everyone especialy myself etc. Then a few days later I'm returning to life and the lights start to come on in my head. This has been going on for 3 yrs and is very debilitating. I take 225mg Effexor XL and 800mg lithium but not much has changed.I've been having counselling and CBT too which have helped me cope but not reduced symptoms.Before I was medicated I got better than OK in the 'up' bits, with overwork, unrealistic planning and writing and talking loads. These excitable and energetic bits have largely gone but the 'down' side is bad as ever. Does it sound like bipolar to you? Any suggestions? Thanks! Helen

Dear Helen -- 
Could be bipolar all right.  If you've had a look at my site on BPII  you'll recall that the question really might better be "how much bipolar?" than "yes or no".   Certainly many mood experts would think of "rapid cycling" to label what you describe.  Rapid cycling is associated with antidepressants, and several experts have advocated that the first step in addressing rapid cycling is to slowly taper the antidepressant while relying on (e.g. in your case increasing) mood stabilizers.  However, I cannot make a "diagnosis" at a distance; rather, my website is all I can offer to explain a diagnostic perspective that might have some bearing for  you.  I suppose you could take the
bipolar screening questionnaire and present that to your doctors for evaluation, but even then, you're stuck in "yes or no" again.  Eventually one way to proceed is simply to try the treatment (e.g. increase mood stabilizers, and decrease antidepressants if you're getting better with the mood stabilizers) and see if it works. 

Dr. Phelps

Published October, 2001


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