Psychotic Bipolar Depression
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Q:  Psychotic Bipolar Depression

Hi Dr. Phelps,
Can you tell me about your observations of Bipolar patients that get psychotic while depressed instead of manic. I just read a Bipolar Clinical Management Medscape article that said that 30 percent or so of people with Bipolar Depression get psychotic. Do you see it often? Do you handle meds differently in those cases? My son is psychotic again and I was hoping to gain some insight. The main Bipolar books haven't mentioned it.Thanks so much.....


Dear Ms. B' -- 
Yes, I do see that combination of depression and psychosis quite often in bipolar disorder.  For an official, if technical discussion of this topic, try this article on 
psychotic bipolar depression.  Admittedly there is an emphasis on psychosis as part of "mania".  Admittedly, there is a tendency to see psychosis as linked with mania, such that when psychosis is seen in bipolar depression, it's called "bipolar mixed state"; as opposed to a depression with psychotic features.  Interestingly, as you've probably learned, psychotic depression is a well-recognized phenomenon, though it is not technically a bipolar variation (some authors think it is...).  The important thing, obviously, is to keep one's eyes on the symptoms and not get too confused with the lingo.  

Dr. Phelps

Published October, 2002 


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