Q:  Late-life Onset of BP & Nothing has been Effective

Are you able at this time to offer Transcranial Magnetic Stimulation for a Bipolar II patient? Nothing so far--medication, exercise, psychotherapy-- has been effective for my husband who developed late-life onset of this illness after taking anti-depressant for the first episode of depression in his life at age 65 and for the past four years, despite many different medication regimes, has been rapid cycling about every 4-6 weeks. Although at present he is taking Lamotrigine 200mg, Depakote 1000mg and a very small dose of Seroquel to help his disturbed sleep (25mg.), I think the anti-depressants he took in the past contributed mightily to his current cycling pattern. While he is mildly hypomanic during his "up" periods, he is profoundly depressed during the low part of the cycle.
 

Dear Ms. B' --
This is tricky.  Late-life onset of bipolar disorder may not be the same animal that we understand from experience with 20- and 30-year olds. But I'll admit TMS is not the first treatment that would come to mind for the picture you've painted here, even if it was available. Certainly ECT (electroconvulsive therapy) does, as this has long been used, particularly in geriatric severe mood disorders. Not as famous for it's anti-manic effects as it's antidepressant effects, but it can work so should be on the list if many other medication (and light manipulations?) have been tried. 

Dr. Phelps

Published July, 2006