Relationship between Bipolar & OCD
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Q:  Relationship between Bipolar & OCD

I have been off Depakote for a couple months now. I've only been on wellbutrin. I have not exprienced mania per se, but have been unable to stop obsessing about a group of people.

Is this some soft type of mania? Someone suggested treating this with Luvox.  Does Depakote or another ms help with this sort of thing? I have a mental health appointment this week. I just moved and am starting over with a new doctor.

Dear Ms. S' -- 
There is definitely a relationship between BP and OCD.  We see an overlap of symptoms all the time.  The problem, as you may have already figured out, is that serotonergic antidepressants are 1/2 of the treatment for OCD (the other half is ERP, a behavioral therapy, which is regarded as a clear necessary component of full treatment for anybody with OCD, these days; you can read more via this
description of ERP).  Luvox is one of those.  Yet we also know that antidepressants can make bipolar disorder worse.  So generally we are forced, because of this, to treat the bipolar disorder first; which means avoiding antidepressants, at least to start, and in my view, if at all possible.  Here's a little relevant chunk on this subject, with  supporting references, from my website, talking about this: 

OCD has a complex relationship with bipolar disorder.  I'm certain I've seen some patients start out looking like they have classic OCD and end up looking like they have definite bipolar disorder without OCD.  These two conditions might be part of the same thing somehow, at least in some people.  At least we know they are found together very often, much more so that one would expect.  In one study, 20% of people with bipolar disorder had OCD, twice the number seen in unipolar depression (which is also higher than people with no diagnosis).Chen

A group of researchers has looked at how OCD and bipolar relate.  They found that whereas unipolar depression was "incidental", i.e. not clearly related to the OCD (although common), by contrast bipolar disorder seemed to be more directly related to the OCD.  For example, people with religious and sexual obsessions as part of their OCD were more likely than those with other obsessions to have bipolar disorder.  The authors specifically recommend that bipolar disorder take precedence over the OCD in terms of which is treated first.Perugi

Bottom line, in my view:  I'd focus on treating that symptom of obsessing about a group of people as though it were a symptom of bipolar disorder, a manic-side symptom and therefore one which requires a mood stabilizer to address it, until it was clear that this approach was not going to work.  You could certainly augment with ERP in the meantime, as that is not known to make bipolar disorder worse!  All of this needs to be discussed with your doctor and is only my opinion based on the information you provided.  I hope this helps you. 

Dr. Phelps

Published October, 2002


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