Q: Do I Need These Additional Meds
I recently had an "nervous breakdown" brought about by the
near collapse of my marriage. I became suicidal and was hospitalized
against my will (our state has a legal Act that the police can invoke).
I was released from the hospital after 3 days and put on Wellbutrin.
Within 2 days of starting this medication I had a euphoric hypomanic
episode that lasted at least three or four days. This was my first such
episode, and the change from suicidally depressed to euphoric occurred within
the span of a few minutes. This was my first experience with such a state,
although I have had many episodes of being inexplicably irritable for several
days at a time both before and after this incident.
About two months later I had my first visit with a psychiatrist since my stay in
hospital. My focus was to discuss how to STOP taking Wellbutrin. Instead
he diagnosed me as Type 2 bipolar and prescribed Lithium and Zyprexa (in
addition to Wellbutrin). I was shocked and thought he was completely
However, I am an open minded person, so I have been on a lot of BP2 websites
trying to evalutate the validity of his diagnosis (by the way, your website is
by far the best source I have come across - Thankyou!). I took the Bipolar
test you refer to in many parts of your website and score 7 yes answers in part
1, yes to part 2, and yes to part 3 (slight problems). This test barely
I guess I don't consider myself as having a serious mental health problem
because this was the first and only time for both major depression and euphoric
hypomania. In addition I have had a very successful career as an executive
in a fortune 500 company (by the way this job requires me to be away from my
family 70% of the time, making an average of 4 flights a week. My wife
says that my irritability coincides with taking this job 3 years ago).
After being off for nearly three months I am back at work. I am
functioning nearly as well as I used to, though my perspective on what is
important has changed.
Do I need all these additional medications? Is'nt severe depression
sometimes warranted by severe emotional circumstances? Does one bout of
harmless hypomania brand me Bipolar 2? I have a brother who is an
emergency physician, and he shares my concern. I am NOT taking the
additional medications. I know you can't advise me on whether to take them
or not. What risks are there to me by not taking them? Is it
reasonable to say "this medication is not appropriate for my
I really don't think these episodes will reappear any time soon.
Dear Larry --
You could be right, and I hope that's how it turns out: you could go the
rest of your life without another such episode; or you could have another clear
mood shift anytime (particularly, statistically, if you were to stop the
medications; and even higher likelihood if you stopped the lithium without
tapering it over a month or more). But, you could be right. There
are folks who will only ever manifest hypomanic symptoms when taking an
antidepressant medication (dubbed "bipolar III" by some mood
experts). Do such people need to take a mood stabilizer to prevent either
subsequent mania? Well, no, if we by some magic knew there were
BPIII, not BPII. See the problem? We can't know that until we see
how things go for you. Many, many folks have one episode like yours, do
okay for a while, then have more such symptoms. So, the point is, only the
future will tell what your diagnosis truly is.
So, the real question is, how much do you stand to lose
if you have another episode, even a more subtle one, or even just more symptoms
of irritability? Can you afford to have those symptoms showing up?
If the answer is clearly no, then you really should be extremely cautious about
your choices at this point. In any case, when you decide you're going off
these medications, if that's what you conclude you wish to do, you should make
that intent clear to your doctor who can then help devise a monitoring system
that might catch emerging repeat episodes at their earliest manifestation; and
design the most cautious tapering (of one medication at a time...).
Congratulations for your open-mindedness. I hope
you can see that it's one of the things that is most in your favor at this
point, whatever your future course is going to be; i.e. if you can see what's
really happening to you, not what you would wish it to be, you'll be in the best
position to make good decisions. Bipolar disorder can be extremely tricky
about how much insight you actually have at times, so working hard to keep that
open mind could be pretty crucial, and I doubt that it will hurt you if all goes
very smoothly from here. I hope that's the case, no matter what
"diagnosis" you end up with.
Published December, 2001