Diagnosed Bipolar at Age 71
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Q:  Diagnosed Bipolar at Age 71

Good afternoon.
 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. 

Dr. Phelps

Published August, 2005


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