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Mental Health  (Expert Forum)
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Bi-polar
Answered by
Roger Gould, M.D. - Mental Health, Wellness
Questions posted in the Mental Health forum are being answered by Dr. Roger L. Gould, author of the Mastering Stress and Depression program and affiliated with the UCLA. Department of Psychiatry. Topics covered include anger, attention deficit disorder (ADD), bipolar disorder, dementia, electroconvulsive therapy (ECT), learning disabilities, memory, obsessive compulsive disorder (OCD), panic, personality disorders, phobias, post-traumatic stress disorder (PTSD), schizophrenia, stress, transitions, and work problems.
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MedHelp Member's Question

Bi-polar

by tercel, Jan 30, 2003 12:00AM
I posted a message a few days ago concerning a 75 year old women who was recently diagnosed with bi-polar based on a hyper reaction she had to the anti-depressant celexa. I have since talked to her doctor and he said that they actually tried two different anti-depressants that produced the same reacaction. But I'm still not convinced that she is bi-polar since she has never had any bi-polar symptoms in her entire life. Is it possible that she is just really sensitive to these types of medication? I'm also concerned that since she has been taking depakote she has a really difficult time remembering which she never had before taking this medication. She is also very tired all the time. At her age I'm also concerned that the medication will actually cause dementia. However, her doctor seems unconcerned about these side effects. Are there medications other than depakote that she could take that would not cause these side effects? She is currently taking 625 mg of depakote per day. For a couple of days she was on only 500 mg of depakote and she was more alert and felt fine. However, they increased the dosage back to 625 mg again for some reason? I'm getting really frustrated trying to talk to her doctor and I would really appreciate any further input you may have. Thank you - tercel
Doctor's Answer

by Roger Gould, M.D., Jan 31, 2003 12:00AM
My opinion remains the same, pretty much along the lines of what you are thinking.  You should ask for another medical opinion, a consultation.  The medication she is on definetly causes these kind of problems, and overmedication in people of this age is a serious problem, and potentially quite detrimental.



Its still true that one does not make a diagnosis of bipolar based on the reaction to drugs.
Member Comments (5)

by Liquidfrequency, Jan 31, 2003 12:00AM
Yes, there are other meds for Bipolar that are often better than Depakote...  Tegretol, Lamictal, to name two...



Depakote usually causes weight gain, and a lot of people don't tolerate it well.  Lithium can often be used also.



The doctor was correct, though, in diagnosing Bipolar.  A manic episode resulting from anti-depressive medication usage is a classic indicator for Bipolar.



The anti-seizure drugs are working very well for many people.  Tegretol, Depakote, Lamictal, and others are all in this class of drugs.  In addition, for anxiety, some p-docs are using a microdose of antipsychotic medication, and also a small dose of Synthroid (thyroid replacement med.)



Good luck!!

by Liquidfrequency, Jan 31, 2003 12:00AM
Forgot to say....depending on how long she's been on the Depakote, almost all of the anti-seizure meds cause tiredness at first, and can have other assorted side effects that usually go away in about a month.  Was depression the reason for the anti-depressive meds?  If so, often times the Bipolar meds also treat the depression, in addition to balancing out the mood swings.  In Bipolar II, there really isn't a "classic" manic period, it can be expressed by irritability, and anxiety, as well as feeling extremely good.  Some Bipolar II's never have an episode of feeling very good, they simply have periods where they are edgy and irritable, and tend to be jittery.

by tercel, Jan 31, 2003 12:00AM
To: Liquidfrequency
Thank you for your comments. It is my understanding that a first episode of hypo-mania indicating bi-polar in someone over the age of 70 is very rare. She was experiencing some anxiety but she was mostly depressed and afraid after she received a phone call from her doctor that she needed a CAT scan right away indicating that her cancer may have returned (she had cancer in May of last year). The CAT scan showed no cancer but this is when she became very depressed and stopped talking much and stopped eating very much. She has never had any type of manic episodes her entire life and that is why I still question a bi-polar diagnosis. Thanks for your input -

I really appreciate it. tercel

by SJSsurvivor, Apr 18, 2003 12:00AM
Hello, my name is Lindasy. I'd just like to start off by giving mopinion on some of the medications that were suggested by Liquid.... to use for bi-polar. Liquid had mentioned LAMICTAL. I encourage any of you out there who are thinknig about taking LAMICTAL FOR bi polar Disorder think twice and KNOW THE FACTS. I am just 15 years old and 8 months ago I aws diagnosed with STEVENS JOHNSON SYNDROME...which is a supposedly rare side effect of Lamictal. The risk of getting SJS is 1/50 in children under 16 and 3/1,000 in adults. Little did we know..Lamictal was on blacklabel(not FDA approved) for anyone under the age of 16 with bi polar disorder. I believe its approved for adults with bi polar disorder...but yet i couldnt see how anyone would be willing to take a 3,1000 chance of getting a horrible life trheatning reaction..which I got...this is not RARE at all. The chances are very extreme. I aws in a burn center for 6 weeks..a respirator for 3. I  asn't able to eat or drink for a month. my eyes were badly damaged from this...I couldnt talk or speak for approxametly that long. I am just very concered for those of you out there who are/ or thinknig about taking Lamictal. I do not want anyone else going through what I did. If you do decide to take the chance...I'd like to let you know that you should check for hypersensitivity(swollen glands,fever) our doctor did not inform us of this. If you do get hypersensitivity signs please let your doctor know immediately. This very well could be heralding a serious medical event and the medication must be stopped immediately. please feel free to e-mail my mother and i with any further questions. ***@**** bless, and be careful.
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