Q: Diagnosed Bipolar at Age 71
It is my fiance that has been diagnosed with bipolar or actually mania because
the doctors connot figure it out. After having all the tests, MRI, MRA,EEG,etc.
with only positive results. He is being treated by a psychiatrist, been
interviewed by a neurologist ( who tends to think it is a neurological problem
as opposed to psychiatric one, because of his cognitive responses) Roger is 71
years old...never been ill, never had depression or mania tendencies, with NO
family history of "craziness" or bipolar!
His manic episodes began only 7 weeks ago...he has now been in the psych ward
for the past 15 days. They are treating him with DEPAKOTE and as of yesterday he
is at level 1000. BUT...I only notice a very temporary improvement, fr only as
long as 6 hours.
What would you recommend AND finally what else could possibley be the problem?
THANK YOU. I await your reply.
Dear Ms. P' --
This may be one of those cases of "they're both right". Late life onset of
bipolar-like symptoms are very commonly associated with some sort of underlying
medical event or problem, most commonly a stroke, but also including infections
and head trauma and medications. Thus it can be seen as a "medical" or
"neurological" issue. At the same time, the symptoms can be very classic for
bipolar disorder, such as classic "mania". In the cases I've seen, when this
happens, there has been very little to suggest that in some way this is "not
really bipolar disorder", in that it acts like bipolar and responds to treatment
like bipolar disorder, so one thinks it really "is" bipolar, perhaps triggered
by the medical event.
Obviously one wonders if by treating the medical event
itself, rather than "bipolar disorder", that might be a more effective or more
direct way of approaching the problem. And thus we look for reversible
medical causes in particular, such as thyroid shift or a tumor or infection. If
no such problems can be found, or if the problem is not a reversible one (e.g. a
stroke), then the focus of treatment defaults to treating the symptoms as though
they were "just" bipolar disorder. This is not an unfortunate state: fortunately
bipolar mania is usually very treatable. It sometimes does not respond to the
first thing we try though.
At 71, taking a few days to get to 1000 mg is a common,
cautious approach. If he's just gotten to that dose the day before you wrote,
then on the next day I would not expect dramatic improvement. Indeed, if you had
seen (at that point) a clear improvement of any kind, even if not lasting
through the day, then that would usually be a pretty good sign. I hope that by
the time you read this things have come along further, and smoothly.
Published August, 2005