Psychologist Doesn't Think I'm BP II, Pdoc Does
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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 honest.

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 "extremely happy". 

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. 

Dr. Phelps

Published February, 2005


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