My husband has been diagnosed with bipolar and antisocial disorder for 2 years now.  He is currently on Depakote and Effexor.  I'd like to know whether I need to be concerned that he has more then just bipolar.  He can go into a destructive anger explosion in a snap of a finger and not remember all that may occur during that period and however long it may last.  Alot of times the end results in alcohol/drug consumption.  He doesn't recall what has happened in that period of time and usually it is something that is not good.  I've asked his Dr. who is treating him to see if there is any other disorders that might be present, but she took offense to that and dropped him as her patient and forwarded him to someone else.  Our daughter is diagnosed with ADHD, Mood disorder, Intermittent Explosive disorder, and Oppositional Defiant disorder.  Is this behavior supportive of bipolar with blackout periods and anger explosions?  It usually happens at least once or more a day

I just can't get any answers from any doctors here.  Please help me to understand what is happening to him so I can get the proper help.            

Thank you,
Debbie

Dear Debbie -- 
When you are in a position to ask questions and not get "dropped", which I recognize is a potential risk when you start questioning what's going on (leading to this little essay on "talking with doctors"), then you may want to gently wonder whether there's any chance that: 

1. There is an underlying seizure-like condition that might be detectable with an EEG (electroencephalogram), and worth ruling out with that test; and

2. The Effexor could be making the presumed bipolar disorder worse, and thus keeping Depakote from being fully effective; and whether, if these are "manic-side" type symptoms, another mood stabilizer might be a good thing, perhaps then later tapering the Effexor after the symptoms are better controlled (as it sounds like trying to do this fast would be a good idea, and tapering the Effexor should in my opinion, if you end up going that route, quite slow, like a month or so or more depending on his current dose). 

The fact that your daughter has similar symptoms does not really help illuminate his diagnosis, in this case, as all her diagnoses can have both a genetic and "environmental" component, as could his symptoms. But the "blackouts" make thinking EEG worthwhile.  And, if you were in any position to influence this, e.g. by looking into attending an Al-Anon group, he needs to take the alcohol out while you all are trying to get this figured out. Easier said than done, I know. good luck with all that. 

Dr. Phelps
 

June, 2005