Bipolar V Disorder
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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 seeing patients.  

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 used antidepressants. 

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.  

Dr. Phelps


Published December, 2004

 

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