I was diagnosed with late onset at 37 years.  That was 15 years ago and I have been mostly stable with good meds and a great medical team (GP, Psychiatrist, and Psychologist).  However, I am having a liver biopsy tomorrow and autoimmune hepatitus is strongly suspected.  That normally means a lifetime on and off CORTISONE.  I'm really scared about this.  My GI doesn't know much about bipolar and my Psychiatrist doesn't know much about Autoimmune Hepatitus.  How can I help facilitate a dialogue between the two?


Dear Ms. J' --

That's a tough one, as you have come to understand. Not everyone with bipolar disorder worsens on steroids, but as you have learned, it is a very substantial risk. In general, we can try to cope with that, just treating whatever symptoms emerge. Where possible, tapering on and tapering off cortisone-- as opposed to jumping in, and then later stopping suddenly -- it is probably a good idea.

Obviously we in psychiatry would want the primary care doctor, and/or specialist, to make every effort toward using alternative means of immune suppression rather than a steroid. But as you say, we in psychiatry are not well versed in autoimmune diseases, so we are not really in any position to direct treatment there. The point here: in my view the solution is not a "dialogue". Unfortunately, there just isn't that much to talk about beyond saying "don't use them, unless you absolutely have to!", at which point, if the answer is "we have to", then we in psychiatry just cope with that.

Sorry, not much to go on there. Good luck with that.

Dr. Phelps



Published May, 2008