I am alittle confused about the dx my daughter has "hypomania" we have her on a mood stalizer (Depakote) and she was doing well, just recently starting having migrane like headaches and sick to her stomach, we dropped her down to 500mgs, headaches are better and no stomach upset (nausea).  To be considered BiPolar do you have to have depression as well, I am assuming that is correct..but when you only have hypomania, then are you still bipolar or does this fall into the bipolar dx, does that make sense?  Also, we did speak with her dr about the headaches, she had been on the 750mgs about two weeks before they started and she didn't feel it was related..but we actually stopped the med for a few days and the headaches went away, but after the third day, she became manic again..so I asked if we could try 500mgs and see if the headaches come back, so far so good.  Her level was 107 at 750mgs, I am also assuming that she is not metabolizing this med quickly, since that seems to be a low dose (she's 13).  I am starting to see alittle of her behaviors come back, but not sure if that is the dosage or if her level dropped too low
when we had her off and now we need to wait for the level to increase again.  I do have to call the pdoc in a couple days to let her know how we're doing.  I do want to stay with the Depakote as long as possible since she had such a good response (other than the weight gain) to it.

Thanks.

Anna

Dear Anna -- 
You're doing a good job trying to determine if the Depakote is causing the headaches.  If weight gain is already in the picture, you can try changing to the new "ER" version that seems to have less of that problem, particularly at this dose range (but remember that only 85%  is absorbed, so two 500's = only 850mg).  Remember there are plenty of alternatives, although fewer have been well studied at her age (there are still some psychiatrists worried about causing polycystic ovarian syndrome in young adolescent girls with Depakote; how much to worry is still controversial; even those who worry more seem to agree that if weight gain doesn't occur, the patient is less likely to get this problem.  Read the section on my website about this for more info').  

As regards the diagnosis issue you raise, there is strong concensus that having hypomania means "bipolar" all right and should be treated as such; there are some folks with bipolar I who only have manic episodes, for example.  

Dr. Phelps