Dx'd Bipolar at 71?
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Q:  Dx'd Bipolar at 71?

Good afternoon.
It is my fiance that has been diagnosed with bipolar or actually mania because the doctors connot figure it out. After having all the tests, MRI, MRA, EEG, etc. with only positive results. He is being treated by a psychiatrist, been interviewed by a neurologist ( who tends to think it is a neurological problem as opposed to psychiatric one, because of his cognitive responses) Roger is 71 years old...never been ill, never had depression or mania tendencies, with NO family history of "craziness" or bipolar!
His manic episodes began only 7 weeks ago...he has now been in the psych ward for the past 15 days. They are treating him with DEPAKOTE and as of yesterday he is at level 1000. BUT...I only notice a very temporary improvement, fr only as long as 6 hours. 
What would you recommend AND finally what else could possibley be the problem?

THANK YOU. I await your reply.

Dear Ms. P' -- 
Not knowing more than this, I'd hesitate to make any recommendations at all. So far the team seems to be responding in very standard ways: suspecting something might be triggering bipolar symptoms, looking for them (with those tests you named), and still remaining suspicious despite the lack of evidence turning up. Meanwhile, they treat the symptoms with a very standard agent at a standard dose (low for young folks, high-medium for an older person; they may do a blood test soon to see what level in the blood results from this dose, though not doing one would not be a sign of poor management, as sometimes we just push the dose until the symptoms are controlled or a side effect emerges and save the lab test for when things are not working out as expected). 

As for what might possibly be the problem: there are brain changes the tests you listed can't see: small areas of neuron death, or neuron hyperactivity, that the test can't pick up. Or there might be some sort of metabolic shift in response to a new illness elsewhere that hasn't declared itself yet.  But rather than beginning to worry about what other such problem might be lurking out there yet to be discovered, I'd encourage you to remember: sometimes this just happens, a first manifestation of bipolarity at age 70 or so, when it never was there before.  In such cases we never find some other problem that was the cause; though unusual, it is not at all unheard of for bipolar disorder to just show up even at more advanced ages.  So, although the doctors are doing the right thing making sure there is not something else there that might be the cause and thus need to be treated (instead of just treating the symptoms), the reason for the search is more to make sure that there is nothing being missed than a desperate hunt for the "real" cause.  After that, it's back to the approach we psychiatrists have been stuck with for decades: treat the symptoms and hope that years from now the "real cause" will be better understood. 

Dr. Phelps

Published November, 2005


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