Do I Need These Additional Meds
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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 wrong.

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 indicates Bipolar.

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 circumstances"?

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. 

Dr. Phelps

Published December, 2001


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