Dear Dr. Phelps,

Last year I was diagnosed with Bipolar II.  Since then I've been on different medications with varying degrees of success.  In January of this year I was put on 500mgs of Depakote.  I was doing well until September when I stopped taking my meds because I felt great.  Well it didn't take me long to  start having problems.   Within six weeks I started to become depressed.  Before I knew it I had a major depressive episode.  Needless to say I learned my lesson and plan to continue taking my meds!  I was out of work for six weeks, the first time that has ever happened.

I have two questions for you.  The first is why when resuming taking the Depakote why have I developed a tremor?  It is perplexing to me not to mention frustating trying to cope with it.  I also am taking 150mg. of Effexor which my doctor is starting to taper down.  My second question has to do with dealing with the stigma associated with mental health work absences, that is how do I deal with people that ask questions that really aren't their business?  By the way I am a forty two year old  woman .  I appreciate any information you can give.  

Thanks,
Leah

Dear Leah -- 
First, the tremor: if you're still on Depakote 500 mg, I wonder if that might somehow be related to Depakote plus Effexor, as it would be unusual for Depakote to cause this at that dose (but probably not impossible).  

And as regards the stigma -- this is a very personal decision, how much to reveal and to whom, particularly in the work setting.  In general my patients seem to be saying that explaining only the minimum is best, unless there's a clear "need to know" or the person is very trustworthy (e.g. won't tell a bunch of other people, and won't freak out him or herself at the diagnosis -- and perhaps, is willing to learn more her/himself).  What's "the minimum"?  Something like "oh, I had some medical problems I had to deal with"; and when they ask more,  a polite "oh, it was pretty complicated and I'd prefer not to discuss it"; and when they press for more, "I'm sorry, I really would prefer not to discuss it".  Beyond that might be dealing with a situation where a counselor/therapist could help you evaluate your options.   

Other people with bipolar disorder here on this website might have lots of experience to share with you on how they've handled this.  Try the BipolarWorld forum or the email groups you can access from the BipolarWorld homepage (right column).  

Dr. Phelps


Published December, 2001