Abnormal Fatigue Episodes a Form of Bipolar...?
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Q:  Abnormal Fatigue Episodes a Form of Bipolar...?

Our daughter was diagnosed with Dysthymia about 14 years ago, when she was 11 years old.  She has been on anti-depressants almost continually for the last 14 years (Zoloft, Wellbutrin, Celexa).  About 10 years ago she started have abnormal fatigue episodes even on the medications.  Increases in the medication has not improved the situation.  For the last 5 years the episodes have been worsening dramatically.  For 3 weeks out of every month she is "normal"... eats well, exercises, is social etc.  For one week each month, she can not get out of bed, her speech slows dramatically, she at times eats and drinks so little that her electrolytes go down to the point that she has seizures.  It is possible that the fatigue cycles could be tied to her cycle, but it does not always coincide.  The symptoms are much worse in winter than summer.  At time she has 2 cycles of fatigue in a month.  Could this be a form of bipolar II, maybe mixed with seasonal disorder as well? 

Dear Ms. L' -- 
The short answer: "yes", it certainly seems possible this is a "bipolar variation".  Your having included the emphasis on her antidepressant treatment suggests you are already wondering whether the antidepressants could be making things cycle, which I too would wonder, although I should emphasize that I would not necessarily start by assuming that "bipolar disorder" is needed to explain what is going on.  

For example, I just read an old colleague's analysis of vitamin D levels and how they might relate to both depression and seasonal affective disorder.  He's been pretty careful with his literature review, it looks like;  although he's a rather unusual fellow himself, as I think he might be the first to acknowledge, so I'd take what he's saying with a big grain of salt until some more mainstream psychiatry types look over his hypothesis and start commenting on it, which, if he's right, they will eventually do, but probably not soon enough -- especially if he's actually right! 

Dr. Phelps

Published October, 2004


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