Q: Response to Lithium & BP Diagnosis
I am mental health professional, psychiatric R.N., Licenced
MFCC, PhD. I am very familiar with the DSM-IV. I have had lifelong severe
depression, tried many antipressants with only partial relief with Wellbutrin, but
continued almost obessional, driven, suicidal thoughts. I was recently started on
lithium. Finally, after reaching a dose of 1800mg I am completely free of
suicidal thoughts which has now lasted for 4 months. My psychiatrist changed my
diagnosis to BipolarII but I do not meet any of the criteria for hypomania other
than some inner restlessness, no
other symptoms. I have used lithium in the past as an adjunct to an
antipressant, up to 900mg with no response. My question is: Does the fact that I
have only responded to lithium automatically change my diagnosis to Bipolar even
though I do not meet the criteria? Also, If there are any resources you might be
aware of on this could you please direct me to them. I have searched tirelessly
for some on the net. I'm ha!ving great difficulty accepting this diagnosis.
Thank you very much for your response.
Dear Dr. M' --
Fair question. The quality of thinking you describe -- "almost
obsessional, driven suicidal thoughts" -- might count on the "hypomanic"
side of things, as well as the inner restlessness. Decreased need for
sleep? I.e. being able to function well on 4-6 hours for days,
sometimes? You've got a lot of letters after your name -- does that
reflect being able to really crank out the work sometimes, more than most people
you know? Is it like that only sometimes? If it's like that all the
time, you might have what Dr. Akiskal (Hagop Akiskal, formerly of NIMH, now head
of the Mood Disorders program at UC San Diego; and one of the most well known
researchers on the outside edges of bipolar disorder, as you may have seen from
your research) would call "hyperthymic temperament" . Such
people just live close to the hypomanic side of things all the time, no
cycling. But they have relatives with bipolar disorder fairly
Those would be the kinds of things I'd look for to help
support the diagnosis enough for you to find reason, satisfactory to you, to
have to work on accepting the "diagnosis". But you have probably
already recognized that at this point the label is far less important than the
outcome. You'd only really need it at this point if what you were doing
now wasn't enough down the road, and then the question would be whether to add a
little bit of an additional mood stabilizer (i.e. the move that would generally
follow from this diagnosis).
However, I know what you're talking about (I think)
from talking with my own patients. There's something qualitatively
different about the feel of the label "bipolar" versus
"depression". Obviously society doesn't know, generally, about
the fine distinctions between bipolar I and bipolar II. To most people out
there, bipolar means "crazy". So it would be difficult to accept
the label on those grounds alone.
On the other hand, to the extent this is possible (and
I am acutely aware of the limits on this), the more people like you
"accept" the label (or at least people sort of like you, who have more
clearly defined BP II), and are willing to let it be known that they have a
"bipolar variation", the more widely it will become understood that
there are versions of bipolar disorder that don't include full manic
episodes. Over time it is going to become clear that this is a fairly
prevalent condition that must be screened for prior to giving antidepressants,
for example, and such screening would end up identifying quite a few folks who
are then going to face the same problem you're facing: minimal suggestive
symptoms for hypomania, but just enough (including perhaps a relatively
clear-cut family history of bipolar disorder) that they really must wonder about
the safety for them of taking antidepressant medications.
But I digress. I hope you've looked at the
"bipolar spectrum" way of thinking, including as shown on my
about bipolar II. That's the way I'd want you to be thinking:
not "do I have it?" but rather "do I have just enough of it to
warrant this approach?", i.e. "am I just a little ways over there on
the bipolar spectrum, just far enough to make a difference in treatment?"
Good luck with your acceptance work.
Published November, 2002