Q. My fiance' has been taking the usual prescribed drugs for
Bipolar Disorder. We recenttly saw a TV program about Margot Kidder
(the actress) who also has Bipolar.
In the show she mentioned that she hd Bipolar and had been taking
drugs and was fed up taking them. She now and continues to be treated
with acupuncture and feels she has the problem under control.
Can you give us any advice concerning this treatment and how can
we contact the person performing the treatment.
Sincerely,
Glenn
A. There are no studies
that have demonstrated that acupuncture is an effective treatment for people
with Bipolar Disorder.
IKG
Q: i am bipolar and add... my previous Dr. would not prescibe
ritalin so i changed doctors and am now taking 10 mg a day once in the
morning and should take another in the afternoon but don't...i am not sure
this ritalin is working as it makes me a little nuts i am experiencing
mood swings and deppresion but am also taking wellbutrin and depakote..
my life is spiraling downward(again) i am ready for everything to be
working harmoniously but my medicine never seems to be right...please
help!!! should i be on ritalin from your perspective or is it the
other drugs? i want off depakote - i am getting FAT!!!
any knowledge of topomax? sorry this is so lengthy.....thank you
very much!!
respectfully,
jennifer
A: Many people seem to have both
ADD and Bipolar Disorder. In some instances they actually have both
disorders and in some instances the Bipolar Disorder causes symptoms that
looks like ADD, and in yet others the ADD causes mood swings that are mistakenly
diagnosed as Bipolar Disorder. Only a psychiatrist with a good deal
of experience in dealing with ADD and Bipolar Disorder can make an accurate
diagnosis.
Topamax (topiramate) is turning out to be a very useful medication,
especially for
people whose Bipolar Disorder is hard to treat.
For information
on topiramate please see:
http://www.psycom.net/depression.central.topiramate.html
IKG
Q: My friend, Neil, is incarcerated in prison. He planned
and carried out
a murder. Family and friends have reckoned for some time that
he is
bipolar but as yet he is undiagnosed. He has answered yes to all
the
questions in a questionaire to indicate bipolar. He is now open
to the
idea. How often do bipolars commit murder and would he have been
manic
when he did it?
Celia
A: I am unaware of good
data as to the frequency that people with
Bipolar Disorder
commit homicide. If you remember that mania
causes irritability,
impulsivity, and impaired judgement, it is not hard
to understand how
people in a manic state may commit criminal acts.
IKG
Q: My diagnosis was about 2 1/2 years ago as bipolar,
but I do not fit
neatly into any category. I have been hospitalized Oct 97 with a
severe
low but have only briefly experienced the highs where I felt like
I was
drunk. There was an edge to the laughter which ended up in sobs
within
hours. My highs are mostly the racing thoughts and extreme irritability
to the thought of violence against the offending parties. (which
I have
never acted on). Currently I am on no meds but there is the continual
sleep disturbances waking in the night, waking up tired. Lack of
sex
drive, overeating, hermitlike social life, unable to deal with stress.
All of these are low grade but the quality of life is down. Is there
any
hope? I have been on almost all meds in the last 8 to 10 years.
Some
worked for a time, changes were made in dosages. But I am frustrated
is
it chemical or is my thinking so negative now ? Please help if you
can.
A: Many people suffer
with chronic depression sometimes together
with racing thoughts
and other hypomanic symptoms. People with
such mixed states
often do best when treated with Lamictal and/or
Topamax.
IKG
My spouse was diagnosed with bi-polar disorder about 1 1/2 years
ago.
He has been on Risperdal (1.5 MG)a day.
He was an avid kayaker, jogger, and skier. He has responded well
to the
meds, but has no desire to do any of these sports, nor anything
else. He
has gained over 20 pounds. He is only 5'4" and weighs over
150!! I've
noticed that he has low self-esteem and absolutely no desire and
energy
to even try to get back into shape. Is this normal?
I agree with him
that his personality is totally opposite now. When he comes
home from
work, he eats dinner, then heads to the couch and crashes every
night!
Should he be on something else besides Risperdal?
A: I
prefer not to use antipsychotic agents such as Risperdal to
treat people with
Bipolar Disorder because of the possibility of
tardive dyskinesia.
It sounds as if your husband is depressed and
should be evaluated
for possible treatment with the combination of
a mood stabilizer
+ an antidepressant.
IKG
Q: Good Day Dr.Ivan, My question may be a little strange,
however I am
curoius if you heve heard of Flexyx Neurofeedback System. I understand
it is fairly new. I stumbled across it through a fibromalygia
diagnosis,I am also Bi-Polar and some of the findings seem to indicate
it may help with both. Please advise of your feelings about this
new
process. They have a web site at www.flexyx.com if you have any
questions. I am strongly considering this. Please help me with your
opinion.Thank You,Thank You Donna
A: Please
ask for reprints of studies from peer-reviewed journals
that show that
the technique was demonstrated to be effective
in double-blind
placebo-controlled studies. I will bet that there
are no such studies.
IKG
My question is not specifically about manic-depression, but about
mental
illness in general. I'm doing a research project on the causes of
mental
illness in which I am arguing 3 sides: 1)Mental illness is caused
by
purely biological factors.
2)Mental illness is caused
by purely environmental factors.
3)Mental illness is caused
by a combination of both biological
and environmental factors.
I believe the third theory, but I'd love to hear your take on the
issue.
I'm not a professional, just an aspiring psychologist who happens
to
have Bipolar Disorder and would like to know why. Thank you for
your
time.
--Missy
A: If you
are speaking in the most general sense the third possibility
is correct, but
for individuals there are some people in whom their
problem has its
roots 100% in biology or 100% in the environment.
IKG
Q: Hi Dr Ivan
The doctor that I am a partial at just suggested ECT to me. What
do you
think of this treatment.
thanks
Michelle
A: If I had
a severe depression that did not respond to drug therapy
following 16-weeks
of drug therapy, I'd want ECT.
For information
on ECT please see:
http://www.psycom.net/depression.central.ect.html
IKG
Q: I am 44 years old.I was diagosed with manic depression
two years ago. I take 2700 mg of neurontin, 20 mg of celexa, and 10 mg
of aricept daily.
I am considered to be a rapid cycler. I was first prescribed depakote,
but I had a horrible reaction to it. I am better on the neurontin
but
far from perfect. Do you feel that there might be a better choice
of
medication for me.
A: Topamax
and Lamictal should be considered.
IKG
I know that you undoubtedly have many things occupying your time,
so I
am asking my question again.
I have been diagnosed Bipolar II but during manic episodes,I
begin to
hear voices, sometimes indistinguishable, sometimes very clear,
sometimes loud, sometimes softer. Sometimes for the entire manic
period
and sometimes not. I have asked others in your field why this
occurs,
and the answer I receive is "The disorder is just like that".
I have
consulted numerous publications and other websites and none has
provided
an answer. I would ask you, Why? Is this something to be concerned
about? I thought that "voices" were indicative of Schizophrenia,
is
this true?
Thanks for your help,
Dan C.
A: There is
a psychotic subtype of Bipolar Disorder in which hallucinations
and delusions may
be found. The mechanism by which these symptoms
are formed is not
known. The prognosis for people with the psychotic
form of Bipolar
Disorder is MUCH better than the prognosis for people
with Schizophrenia.
Q. Dear Dr. Ivan,
I have tried to e-mail you in the past, but I may have been
somewhat incoherent at the time, so I
thought I would try again. I have been diagnosed with bipolar
1, rapid cycling and have been
cycling for over 2 years (hypo/manic/mixed lasting about
1-3 weeks, depressions a month). I
have been on depakote, tegretol, lamictal, and combinations;
about a dozen AD's, klonopin,
ativan, zyprexa, risperdal and seroquel. My pdoc of 2 years
felt he could no longer help me, and
I went through several more pdocs with a recent hospitalization
for an overdose that was judged
to be suicidal but I felt happened because I just couldn't
stop my agitation- both physical and
mental. I got Dr. Akiskal's name from your site, however
he no longer accepts patients. I have
abused drugs in the past, but no longer do so. I have no
psychiatrist at present and am taking
6mgs of klonopin a day because that (and risperdal) has been
one of the only drugs that makes
me feel better. My internist is willing to give me medications,
although he is pushing me to go to a
psychiatrist. If you have any names to suggest (I live in
San Diego), or a course of action to take,
I would greatly appreciate it. I was a scientist (cancer
research) but am no longer functioning
very well. I am 40, married and have a child. Sorry for the
length of this post and thank you for
your time.
Sincerely,
Judy
A. I think that anyone
with a complex history such
as yours should be treated
by a psychiatrist
who is familiar with
the treatment of individuals
with Bipolar Disorder.
You might ask Sidney Zisook
MD (619-497-6618 to
help you find a psychiatrist
with more than
average skill in treating
people with Bipolar
Disorder.
IKG
Q: My son has been on Tegretol and Seroquel for a year
and a half. I feel OK about
the Tegretol, as in the past it has been a good stabalizer.
Isn't Seroquel a neuroleptic? My
understanding is that it is used to bring the mania down.
He wants to decrease the dosage and
no one seems interested, or they are afraid.
He was medivac'ed from the Tongan Islands in summer of 1998,
entering Queens Hospital in
Honolulu with neuroleptic malignant syndrome, had been totally
delirious from high doses of
Haldol in Tonga and was given massive doses of Thorazine
on the flight to Hawaii. Thereafter,
he had tons of ECT sessions and was started on the Tegretol
and the Seroquel. He is in a group
home now and is really normal, miraculously. So my
question is about the Seroquel. Is it
normally used long term??
A: Long term antipsychotic medication is occasionally
necessary to help some
people with Bipolar Disorder
remain euthymic.
Unfortunately, many psychiatrists
after using antipsychotic
medications to treat
acute manic or depressive
psychoses are reluctant
to discontinue these
medications when the psychosis
has remitted. This
unfortunate practice exposes
patients who are so treated
to the possibility of
developing tardive dyskinesia.
IKG
Q: Hello Dr. Ivan,
I have been on medication for bipolar affective disorder
since 1980. I'm now 44 yrs. old and it
seems to me as I've gotten older I have required more meds
and different kinds. I'm on 350mg.
of Wellbutrin, 1200 mg of lithium, 30mg of buspar and 3.75
mg of clorazepate T.I.D. I almost
forgot I also take Levoxyl and Volterin. I feel like
death most of the time and have talked this
over with my Dr. many many times but she seem to think
I need all this junk. It's very hard on
me to hold down a job. I've tried and have done it for years
but I can't do it anymore. I told her
this and she said I was too high funtioning to get
disability. That's because I have always pushed
myself to work but as I have gotten older I have found I
have sooo much problems with my
memory and stress with driving, people at work and the job
it self. Please can you help me???
Thanks so much for your time and I really do appreciate any
help you can give. I've even tried
to go to college but had to stop-stress!!! Everything
I try doesn't seem to last long. I do have a
wonderful husband but sometimes I feel he is sick of me being
sick though and I don't blame him.
Sincerely, LaDawn
A: I think it may be time
for you to have a
consultation with a psychiatrist
who is
expert in the treatment
of individuals with
Bipolar Disorder.
A list of such psychiatrists
may be found at:
http://www.psycom.net/depression.central.psychiatrists.html
IKG
Q: I read on a bipolar sight that tenuate not
tenuate dospan is a reasonable drug to
combat the weight gain that one has gained through the use
of the polypharmacy over the years.
Could I be
reasonably certain that it is safe for me? Joyce
A: There is little evidence
that Tenuate or any other
"diet pill" will cause
sustained weight loss.
Many psychiatrists are
now prescribing Topamax
for people with Bipolar
Disorder who have gained
a significant amount
of weight from previous
treatment with mood stabilizers.
Topamax is the
first mood stabilizer
that regularly causes weight
loss.
For information on Topamax
please see:
http://www.psycom.net/depression.central.topiramate.html
IKG
Q: What is your opinion of the prevalence of high IQ and creativity
accompanying
bipolar disease?
Does it seem as though the bipolar symptoms lessen (especially
if the depression is treated)
sometime in the 40's? Do you think that people have
just learned to handle it better by then?
Do bipolar people get divorced more than other people?
A: While some people with
Bipolar Disorder note a
reduction in the frequency
and/or severity of their
episodes as they get
older, this does not happen
to everyone with the
disorder.
Divorce is unfortunately
common for people with
Bipolar Disorder.
IKG
Q: I've lost my kids,my relationship with my husband
is falling apart and so am I every
time they put me on a new med the side affects are too much,mostly
headaches wich I'm prone
to anyway I want to disapear its been 2 yrs since I was diagnosed
and I've tried all meds Im at
my wits end I've overdosed a number of times and now I want
to make it permanent! I need to
know if there is any hope left? PLEASE RESPOND IM IN TROUBLE
AND I KNOW IT.I
SHOULD KNOW IT BY NOW.
A: Many people have the
impression that they have
tried all the available
treatments for their
Bipolar Disorder and
that nothing works for them.
Complex combinations
of thyroid and multiple
mood stabilizers (such
as Lamictal + Topamax) have
helped many people whose
Bipolar Disorder has
previously been impossible
to control.
IKG
Hello Dr. Ivan,
Nine years ago I was diagnosed with Bipolar I, and now take
Lithium, Prozac and Tegretol
(Carbamezapine) to treat it. My question concerns the quality
of life I might expect while living
with this disorder, as well as my expected longevity. I graduate
at the end of Winter 2000
quarter with a B.A. degree in Computer Information Systems,
which would be very encouraging
if not for the problems I have socially. Will I end up working
at the gas station? Who can say.
But I would be interested in knowing how others with this
disability have fared.
Thank you for any information you can give me,
Thomas
Individuals with Bipolar
Disorder have held
responsible jobs including
President of the
USA. With today's
treatments more and more
people with this illness
can look forward to
a long productive life.
IKG
Q: How can I get rid of the 50 pounds thatI have gained since
going on depakote,escalith ,zxprexa(
which I am now off),synthroid and effexor? Please help.
I no longer have a figure and I can't
find any clothes to wear,
A: The combination of a
severe calorie restricted
diet + exercise helps
people lose weight.
Switching to Topamax
as a mood stabilizer makes
the weight loss process
easier as Topamax reduces
appetite.
IKG
Dear Dr. Ivan,
Thank you for your responses to my earlier questions!! I
have some more..
What dosage of depakote is considered to be a maximum daily
dose for a 12 yo 5' 6" 130lb
child? My daughter takes 1,125mg/day of depakote (no
other meds) for bp. Is this a lot? It
does seem to work well but she's gained weight & I wonder
if neurontin or a newer drug with
fewer side effects should be tried.
The bp kids I know are somewhat immature (emotionally) and
have difficulty accepting
responsibility, making good choices, etc. Is this a product
of the bp? How can I as a parent best
help in this area? It is hard to tell what behaviors
to attribute to bp and what is stubborness,
hormonal, immaturity, defiance, etc. I want to be fair and
have reasonable expectations!
A: Depakote is one of the
medications that is
regulated on the basis
of blood tests. There
is no such thing as a
maximum dose . . . the right
dose is the one that
results in a blood level
that successfully control
the symptoms of the
disorder.
As for the matter of behaviors.
Children with
Bipolar Disorder need
structure and help main-
taining routines.
They also frequently need psycho-
therapy to help them
repair their self-esteem that
was damaged by the experience
of being ill.
IKG
Q: I am a manic deppressive bipolar,i have started a new drug
called LAMICTAL it is a mood
stablizer as well as antideprresant, It has done wonders
for me. 10 years of searching for the
proper medication ,is hell on earth,finally im stable life
does have normality after all ,also been in
psychotherapy 7 years that part goes hand in hand .
Have you heard of this new drug? If so what is your advise
about it
Thankyou Susan B
A: Lamictal is an important
addition to the mood
stabilizers that are
available. It has helped
many people who have
not responded to other
mood stabilizers.
For information in lamictal,
please see:
http://www.psycom.net/depression.central.lamotrigine.html
IKG
I have been diagnosed with bi-polar disorder from the age
of 18. I have a niece and nephew. I
got my disorder from my father who got it from his Aunt.
My question is: Will my niece and/or
nephew have a chance of contacting this bi-polar disorder?
A: Your niece and nephew
have a greater chance of
developing Bipolar Disorder
than people from
families in which there
are no people with
Bipolar Disorder.
IKG
Q: My 12 (soon to be 13) year old
daughter was diagnosed in Nov 99 as bipolar
following a suicide attempt (she scratched her wrists with
a screwdriver). Her mother and I are
divorced and this attempt could possibly have come from her
being upset about that.
After reading signs and symptoms of bipolar, I do not see
these signs in my daughter. Is there a
reliable source on the internet that discusses onset in teenage
girls? She is currently being
followed by mental health professionals and is on medication.
I am just interested in finding out
more info before I speak with the professionals so i can
ask intelligent questions. My daughter
has had no other manic or depressive episodes either before
Nov 99 or since.
thanks,
Greg
For information in Bipolar
Disorder in children
and adolescents, please
see:
http://www.psycom.net/depression.central.children.html
Q: Where can I find research on bipolar and children?
A: See question above.
IKG
Q: Is it true that bipolars are more prone to problems
with their blood sugar?
If so what kind of diet is advisable to combat this?
Tim
A: Unless an individual
has abnormal blood tests
indicating difficulties
with sugar metabolism,
there is no need for
a special diet.
IKG
Q: I was told it might be bipolar cause i get this feeling
of emptiness and cry at all times
for no reason and also i get angry and upset at times i can
be fine one minute the next i am a
basket case i have been on Zoloft Serzone and now Wellbutrin
plus lorazapam and Ambien to
try to sleep and none of these meds work and lately i been
feeling like life aint worth it anymore
A: People who have symptoms of depression, and
who
do not do well when treated
with antidepressants,
very well may have Bipolar
Disorder. They should
seek out a psychiatrist
especially experienced
in the diagnosis and
treatment of people with mood
disorders.
IKG
Q: Dear Dr. Ivan,
How does PTSD affect Bipolar and vice versa? Thank you, John
A: PTSD is an anxiety disorder and while people with PTSD may
be depressed they always show certain symptoms. These symptoms include
reexperiencing their old trauma either in dreams or when awake, attempts
to avoid reminders of the old trauma, and often feelings of being unsafe,
even where there is no real external danger.
Bipolar Disorder is not a form of PTSD, although the two disorders
can coexist. When an individual suffers from both PTSD and Bipolar
Disorder, there is a high probability that they will be misdiagnosed as
suffering from Borderline Personality Disorder.
Please see:
http://www.psycom.net/depression.central.topiramate.html
for information on a
medication that can be used to
treat both PTSD and Bipolar
Disorder.
Q: I have suffered severe physical/mental abuse and
believe I suffer the symptoms of being Manic. I was taken to a few
doctors when young, but not told anything. It's getting hard to hide
this from friends and family I feel like I might go into a depressive state
and not come out as I usually do. Please, anything you can
suggest. I don't want to be medicated, but need help. Thanks
Mark
A: From the information you provide it is impossible for me
to determine what is the problem, and what might be done to help
you cope. It sounds as if you need a full evaluation to determine
exactly what is going on. If you need help finding some-one to do
such an evaluation, a list of expert psychiatrists may be found at:
http://www.psycom.net/depression.central.psychiatrists.html
Q: Dr. Ivan, my 12 yo daughter is bp. She is on 1,000mg
of depakote daily and she also takes 500mg of tetracycline/day. Do
they interfere with each other's effectiveness?
A: I am not aware of an interaction between Depakote and tetracycline.
Q. Also, sometimes I can't tell if her irritability is from
mania or depression. Is this common? What would you suggest?
A. Irritability is a very nonspecific symptom. People
who are both manic and depressed may be irritable. Irritability may
also be seen in some people who are in physical pain or who are suffering
from any sort of emotional distress.
Q: Do you feel that lead paint exposure could bring on bp?
A: Lead poisoning may cause psychiatric symptoms which at times
might mimic Bipolar Disorder. If lead exposure is suspected there
is a simple test for lead poisoning.
Q: Do you foresee some of the newer anticonvulsants
being able to be subscribed soon for bp? Why can't they be used now?
A: Many psychopharmacologists are currently prescribing
Lamictal, Neurontin, and Topamax for people with Bipolar Disorder.
Please see:
http://www.psycom.net/depression.central/lamotrigine.html
http://www.psycom.net/depression.central.gabapentin.html
http://www.psycom.net/depression.central.topiramate.html
Q: I'm placing a lot of hope in the future "cure" for bp with
human gnome experiments. Do you see that as our best possible treatment
or if not, what else is on the horizon?
A: I agree that gene therapy is the best chance for a true
"cure" for people with Bipolar Disorder. I think the continuing development
of psychopharmacologic treatments will provide more and more people with
a good means of controlling the disorder until a "cure' is developed.
Q: When a young person (pre-teen) is diagnosed bp does this
usually mean that his/her illness is more pronounced? In other words,
does age of onset equate with degree of severity? Thank
You!!
A: A number of studies have shown that the long-term outcome
is no worse for people whose Bipolar Disorder started in the teens when
compared to individuals whose disorder started later in life.
Dear Colleen & Dr. Ivan,
Thank you again for providing this service! I have some
more questions......
Q: Do you feel that bipolar is a condition of mini brain seizures?
Is this a new theory?
A: It has been proposed that seizure-like activity deep in
the brain plays some role in causing Bipolar Disorder. There is little
evidence to support this theory.
Q: Since the frontal brain seems to be the area that provides
judgement skills, morality, inhibits impulsivity, etc. what studies are
being done in this area for bipolar affected persons? Would you recommend
an EEG be done on your child if you had a 12 yo with bp to determine if
this area of the brain is understimulated? How could these tests
be useful to a parent? How can a parent help to increase stimulation
of her child's frontal brain area?
A: It is not clear that the impulsivity and lack of judgment
that often accompanies mania are specifically related to frontal lobe problems.
An EEG contributes little to the diagnosis and treatment of individuals
with Bipolar Disorder.
