Dx'd Bipolar & has Mania Only : Meds
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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...)


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 


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