Dear Dr. Phelps:

I was diagnosed about a year ago with Rapid Cycling Bi-polar illness.  I had a "nervous breakdown" about three years ago.  I am now on short term disability from my job.  I feel that I am no longer effective in my career as a financial analyst. The past two positions in the past two years that I have held I have not been able to do what they expected.  I'm currently on short term disability from my most recent job.  It's not that I am not working hard or long hours.  I feel that my lithium (900 milligrams) and paxil (10 milligrams)is making me stupid.  I have a M.B.A. and have worked in the same field for over ten years.  I see my Doctor now at least every month.  I feel physically awful and don't have much drive anymore.  I am terrified about more failure.  I'm supposed to be the main support of my family because my husband is disabled on social security.  I'm 46 and I feel really horrible.  I see people twice my age with more pep than I have.  I've been on several different antidepressants over the past several years.  Is there any hope for me or am I doomed?

Thanks.
Valorie

Dear Valorie -- 
Hope is mixed with risk in this circumstance, at least that's my point of view:  you can  try for different treatment regimens that might make you feel more like your old self.  But in the process we couldn't guarantee you wouldn't at some times feel worse than now (i.e. as you don't mention symptoms now).  We can't even guarantee you could come back to what you're now taking and have it work just the same.  

On the other hand, there are now many medications to try.  As you may have read (if not, check out the "treatment" section on my site about BPII), antidepressants can sometimes make bipolar disorder worse, even while making the depression part better.  One of the ways it's "worse" can be subtle "manic-side" symptoms, including difficulty concentrating, or even just a vague "fuzziness" to your thinking.  So you might be having that effect, to account for why you're not able to work.  [Don't stop the antidepressant without talking about all this with your doc'; in any case we taper those off slowly, over several months].  

Lithium is a mainstay medication for bipolar disorder, but there are folks out there who feel slowed down and "stupid" on it: they just can't think like they used to.  Since there are alternatives, you can try asking your doc' to add one then try going (slowly) off the lithium.  

So, you can see there are things to try.  I wish we could just try such things without having to worry about a person's symptoms coming back and then having trouble controlling them.  But if you still have symptoms too, you're definitely in a position to talk with your doctor about trying a different approach. 

Dr. Phelps
 

Published September, 2001