Q: Bipolar V Disorder
I have a question in regard to Bipolar V Disorder. I have been diagnosed with MDD, Recurrent.
Also, I have a daughter who has been diagnosed with Bipolar II
Disorder. In addition, I know that my mother received ECT, but I am
not sure about her formal diagnosis (However, based upon her past behavior, I suspect that she was Bipolar). My question is: When the
criteria for Bipolar V is listed in regard to family history, would my
daughter's formal diagnosis alone be sufficient grounds for
classification of my condition as Bipolar V, or would it have to be
verified that my mother was manic-depressive? Thank you.
Dear Mr. W' --
I had to go search for an official definition of "Bipolar V". This is not a
term we use clinically (meaning in routine patient care). As you know, and I
have reminded myself, in one classification scheme, Bipolar V is:
... used to describe the situation in
which the individual meets the diagnostic criteria for major depression and
there is a family history of Bipolar Disorder
Since this classification system is not "official" in
any respect of which I'm aware, but more a scheme for convenience in
classification of different versions of possibly bipolar phenomena, I think your
question is pretty "moot". It is, at least, from my perspective as a clinician
However, awareness of the issue is not moot at all, but
quite critical. How often is it that someone with a first degree relative (a
daughter or a mother, you see) who has never had any hypomania but does
have recurrent major depressive episodes, might respond better in the long run
if treated more as though he had a bipolar variant? I'm not aware of any
research data on this, but it is a reasonable question to ask, I think.
In fact, if you were to see me in my office and we got
the history of both your recurrent depressions and your family history as you've
described it here, and you were depressed, we'd have an interesting dilemma, in
my view. Assuming at that point that you'd never had anything to suggest
hypomania, there would be little reason not to use an antidepressant, at least
in the view of most of the psychiatrists I know. And yet I would find myself
really struggling over whether we should at least consider using a mood
stabilizer with antidepressant potential; and I would certainly be thinking very
strongly in that direction if you'd had poor long-term responses to typically
In my experience the most typical way that someone like
you comes to my office is with the following story: Prozac (or some such
typical antidepressant such as Zoloft or Paxil) worked really well for a while,
and then you stopped taking it because you were better. Then later, you became
depressed again, so restarted the Prozac/Zoloft/Paxil, and this time it only
worked for a few weeks and then you became depressed again, often at this point
with more difficulty sleeping and some other very subtle features of "too much
energy", such as anxiety or irritability. Usually the dose at that point would
have been increased, which might have helped somewhat, briefly, and then things
got even worse. Another antidepressant was substituted but did not help, and
usually by the time such a person sees me she/he has had 3 or more
antidepressants, and now none are working at all, and often they are causing
some degree of agitation.
I've had very good luck with lamotrigine in such
people. It looks like it might even be more effective if the person has not had
too many antidepressants or spent too long on any one of them.
None of this is intended as an interpretation of your
particular experience, nor as advice for what to do now. However, I think this
way of thinking about "Bipolar V" needs to become more widespread so as to enter
into consideration when people are deciding whether to try, for example, a third
antidepressant; or even a second antidepressant after a "Prozac Poop-out"
experience; or perhaps even when they first consider an antidepressant, but have
an obvious family history like yours. Mind you, I'm one of the only
psychiatrists I know who thinks/talks this way, and I could be way wrong, based
on the rather unusual kind of patients (average of 3 prior antidepressants
before they see me) I see.
Good luck with your treatment.
Published December, 2004