Q: Psychologist Doesn't Think I'm BP II, Pdoc Does
I am 54 years old BPII medical librarian.
I have been on Depakote (weight gain) and Zyprexa (weight gain) which both
worked well, but the side effects of 30 lbs. were unacceptable to me. I
have been on Neurontin and Topomax. I had 90 % of my thyroid removed so I am
told Lithium is not an option.
I am a rapid cycler and have recently begun to have mixed cycles. I walk 6 miles
every morning, completed a marathon in 6 hours in April, am a vegetarian and do
not drink (well maybe once every 4-5 months a drink or two in one evening with
friends). Go to bed the same time every night, etc., etc. My friends say I'm a
poster child for healthy living.
I was on benzodiazepines because of anxiety and sleep problems but I have
problem with suicidal ideation and they are not a safe option for me, I will be
I am titrating off Lamictal because of problems with significant hair loss, I
was also on Wellbutrin for a ten week bout of depression. I was feeling well but
into my third week of titration off meds I am having a recurrence of suicidal
ideation, manageable but infuriating, like an unwelcome guest. I am also having
problems with impulse control which I am so far keeping under some control. I
continue to work throughout my problems except for occasional days off if things
become too overwhelming.
I wonder if there is ANY medication that will ever work? My psychologist
said at my last session that he thinks I bring on my cycles as a self protection
against emotion although I awaken with them after feeling fine the night before.
He also says he does not believe I am BPII but just depressed because he has
never seen me "extremely happy" although I've tried to explain the varied
manifestations of mania. My psychiatrist obviously does think I'm BPII.
Can we "bring on" our cycles?
Could I control my disease without medication somehow?
I am so tired of this merry-go-round from hell, I try so hard for balance and
can't seem to get it right. I am sorry this is so long, I understand if you
cannot answer it.
Dear Ms. "M" --
Thanks for acknowledging that this might be too tricky for me to comment on, as
indeed there are some major complexities in your note. A couple of thoughts:
first, you might refer your psychologist to this
essay on Bipolar II
diagnosis. He could be right, of course. Let's just make sure he's using
an up-to-date conception of bipolar disorder. In one of the models I like best
for handling this kind of thing, (called "consultation-to-the-client",
describing the role of each professional as working for you, but
independently) the idea is that your doctor and your therapist don't have to get
together and work out their differences of opinion, but instead, in this model,
it's up to you to take from each of them whatever they can offer that ends up
being helpful to you. So, your psychologist doesn't have to be convinced -- but
you and he can more easily work from "the same page" if you both have a similar
understanding of the different versions of bipolar disorder that don't include
I'm surprised by the idea that because you have 10% of
your thyroid, you shouldn't take lithium. I guess if you had plenty of other
options to choose from, that would probably be wise, as I would agree there is a
pretty good chance that if you go on lithium, you'll end up having to take
thyroid hormone (another pill to manage) and that if you then stopped lithium
you might even have to continue to take the thyroid hormone. But lithium
has antisuicide properties, and antidepressant properties, so I'm surprised that
with your symptoms that this is "off the list". Maybe there's something here
for me to learn (let me
know, if so). But I think it might be worth re-examining that assumption
and getting a good clear explanation from someone as to why that's the belief.
Waking up with depression makes me wonder how much
you're sleeping. If it's more than a total of 10 hours per 24, that could be
part of the problem (though not easily corrected; yet by working at not sleeping
more than that, you're at least working on the problem without having to use
medications to do so. You could ask the psychologist for help making your sleep
efficient (when you're in bed, you're sleeping), and for help with daytime
activities that make it worth staying awake. Here's a nifty
site on suicidal thinking in case
you ever need it. Good luck with all that.
Published February, 2005