Hi Dr.
My girlfriend has been diagnosed as having both bipolar II and borderline personality disorder. She has perscribed geodon and depakote. When she doubled the depakote she reported to me that she felt nothing towards me and her children. It's like she felt "flat and disconnected." She also reported an increase in anxiety and depression symptoms. When she told her treatment person, that person told her she was going to increase the depakote. Before she started these meds, she told me that she loved me and wanted to build a life together. Now she feels flat about everything. I don't know what to make of it. Could it be the result of the meds, especially depakote?What would you suggest.
Paul
 

Dear Paul --
(I've gotten behind on letters; pardon the brevity of this reply)
Yes, that could be Depakote, which has that effect sometimes (not often, in my experience; and it would be just the opposite of my intent if a bunch of readers started lowering their Depakote after reading this...). But the increase in anxiety doesn't fit this hypothesis; depression yes, I see that occasionally too, but not increased anxiety.

Then there's the worry that "borderline personality disorder", or whatever she has that looks like that, could account for the "flat" feeling, particularly toward you, as "flat" or worse (e.g. rage) is pretty typical in the patterns of relationships with this supposed "disorder".

And I wonder about the Geodon too, as it's place in the treatment of bipolar disorder has not really been established -- so that too seems a possible culprit in trying to account for what you've observed, if only because we have so little experience with it in bipolar disorder (following a friend of mine's approach: "medications are guilty until proven innocent").

Perhaps you could forward your observations to her "treatment person" so at least you would know that person was aware of how it looks on your end of things (voicemail, or a letter, for example).

Dr. Phelps


Published October, 2003