Dx'd Bipolar & has Mania Only : Meds
[Home] [Bipolar News] [Bipolar Disorder] [Medications] [Treatments] [Bipolar Disorder/Job/School] [Disabilities] [Ask the Doctor] [Ask David] [Self-Injury] [Personal Stories] [Graham's Column] [Steven's Column] [Storm's Column] [Columnist Archives] [Suicide] [Community Support] [Family Members] [Expressions] [Greeting Cards] [Books] [Awards] [Links & Rings] [About Us] [Contact Us]

 


Q:  Dx'd Bipolar & has Mania Only : Meds


My sister has been diagnosed with bipolar disorder (2 years ago) and is currently experiencing the same syptoms again. She is in extreme mania with congruent psychotic (delusions) syptoms. I have placed her in a crisis center (same as 2 years ago) and will go to court as her guardian advocate tomorrow.

My question is in the diagnosis and medications. First, her syptoms never include, nor in her lifetime has she suffered from any depression. She exhibits only severe mania -I have had to retrieve her from different states and countries. There are studies involving unipolar, that recognizes only depressive symptoms being present, but I have never found information about strictly manic symptoms. Is it conceivable that a bipolar diagnosis can be made with the complete absence of depression?

Secondly, after her last episode 2 years ago, she was fully recovered in 3-1/2 weeks. Her maintenance medications included neurontin (1200 at night), seroquel (100 at night) and zoloft (50- unsure if am or pm). I am concerned the zoloft may have contributed to her hypomania the last 4-5 months. She was only recently removed from zoloft. Also, is it common to include seroquel as a maintenance drug, even if the mania/delusion is no longer present?

Desperate for any information or related articles that may be of assistance.

(...a follow up to the e-mail just sent. FYI - her labs seem to show no evidence of thyroid disorder, though she appears to me to have a goiter. (I haven't seen report personally yet), however I had elevated t-3 and a thyroid ablation...)

Regards,
laurie


Dear Laurie --
(I've gotten behind on letters; pardon the brevity of this reply)
I can't find the reference but I heard Mauricio Tohen, formerly of Harvard Univ., and one of the world experts on the course of bipolar disorder, say once that 10% of bipolar I patients only have mania, never depression. I wouldn't have thought the number would be that high, but by this authority, it exists.

Secondly, isn't it odd that a woman who's only had manic episodes is being treated with Zoloft, an antidepressant; plus Neurontin, which has been shown not to be of benefit as a mood stabilizer but which does have significant antidepressant properties and in my experience may also be a risk factor for bipolar cycling (so much so that I routinely take it out). Of course, her psychiatrist may be aware of symptoms that neither you or I know about that explain this particular selection of medications.

And finally, I'm glad you noted your own history of thyroid changes. There are mysterious connections between thyroid and bipolar disorder, including episodes of apparent mania that are associated with hyperthyroidism. So that's worth keeping an eye on as well.

Dr. Phelps


Published October, 2003 

 

Bipolar World   1998, 1999, 2000, 2001, 2002, 2003, 2004, 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, 2014
Owners: 
Allie Bloom, David Schafer, M.Ed. (Blackdog)
Partners:  John Haeckel, Judith (Duff) 
Founder:  Colleen Sullivan
 

Email Us at Bipolar World

 

About Us  Add a Link  Advance Directives  Alternative Treatments  Ask the Doctor   Ask Dr. Plyler about Bipolar Disorder   Ask The Doctor/ Topic Archives  Awards  Benny the Bipolar Puppy  Bipolar Chat  Bipolar Children  Bipolar Disorder News  Bipolar Help Contract  Bipolar World Forums  Book Reviews  Bookstore  BP & Other mental Illness   Clinical Research Trials & FDA Drug Approval   Community Support   Contact Us  The Continuum of Mania and Depression   Coping   Criteria    Criteria and Diagnosis  Criteria-World Health Disabilities,  DSMV-IV   Dual Diagnosis  eGroups  Expressions (Poetry, Inspiration, Humor, Art Gallery, Memorials  Family Members   Getting Help for a Loved One who Refuses Treatment  Greeting Cards  History of Mental Illness  Indigo  Job and School  Links  Manage Your Medications  Medications   Medication and Weight Gain    News of the Day  Parent Chat  Pay for Meds  Personal Stories  Self Help  Self Injury  Significant Others  Stigma and Mental Health Law  Storm's Column  Suicide!!!  The Suicide Wall  Table of Contents   Treatments  Treatment Compliance  US Disability  Veteran's Chat  What's New?