Meds & If a Person was Misdiagnosed Bipolar...
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Q:  Meds & If a Person was Misdiagnosed Bipolar...

I have not been able to find a professional (MD or Pharmacist) that has been able (or willing?) to answer this question: if a person was mis-diagnosed as bipolar and was taking the classic meds say Tegretol, Lamictal and Zyprexa what would be the result?

Dear Ms. C' -- 
Now that is a question that shows somebody's really thinking.  I love it.  So, let's say the person "wasn't" bipolar (you may have read my essays about how this really isn't a yes-or-no matter; e.g. see the diagnosis section on my website on
BPII).  And say, she has depression that keeps coming back repeatedly, with intervening "well" intervals (what some would call "recurrent unipolar depression").  So, somebody calls that "bipolar" because of it's recurrence (and the fact that she's already had 3 antidepressants which work for a while then "stop working", and on the most recent one of those, she got pretty agitated... ; or, not, as you wish, as we're going to call this a "mistaken" bipolar diagnosis).  This mistaken doc' picks lamotrigine because of it's strong antidepressant properties.  

So, first, there are the risks of taking any new medication, including rare "idiosyncratic" reactions that can be terrible.  This risk applies to anything one might try, including aspirin or some herbal preparation.  

Second, there are the known risks associated with particular medications, lamotrigine in this case:  about a 1/1000 to 1/3000 risk of getting a serious rash, that has killed a few folks, called Stevens-Johnson syndrome (rate depends on how fast the dose was turned up); and some minor conditions like headache are a little more frequent than on a placebo.  

Now, would it help?  Yep, there are some pretty clear indications that for "recurrent unipolar depression", lamotrigine might be especially good.  Of course, one could say that this is because "recurrent unipolar" is really a "bipolar" variant (as I believe), but that just starts the name game all over again, doesn't it?  

The same three-part story (idiosyncratic; known risks; possible benefits) applies for Tegretol and Zyprexa.  Briefly, taking Zyprexa -- if the person had not recurrent unipolar symptoms but instead a lot of agitation and intense thinking, worrying over stuff to a really irrational extent, for example; then Zyprexa might help a great deal (although in this case one could wonder whether the symptoms justified the risk of profound weight gain, and perhaps even diabetes, that accompanies Zyprexa when used on a regular basis).  And for sleep problems or something that sounded not just like "plain depression" but something more like an epileptic-like change in sensations (deja vu'-like experiences; or episodes of confusion after intense mood changes -- these are all reasons why somebody might pick Tegretol without thinking "bipolar" per se), Tegretol might be very effective.  

So, as I hope you can see, one of the reasons your question is so important is because it illustrates how the "labels" are actually holding us back.  Many psych' practitioners have recognized that focusing on symptom clusters as targets for medication interventions may be more sensible than focusing on diagnosis as a means of picking medication approaches; and the only reason I don't endorse that approach entirely is because there is some value, e.g. in terms of research especially, and in terms of clarifying "prognosis", in making diagnoses.  So I try to think "both ways", and encourage everyone to do likewise.  Thanks for asking. 

Dr. Phelps

Published February, 2003


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