Q:  Having Fainting Issues which are Increasing in Frequency

My adult daughter (24) is bipolar.  She is having issues with fainting.  She has fainted in the past (several  times over the past 6 years) but the frequency is increasing.  She recently started lithim & decreased depakote (from 1000 m to 500 m).  The fainting seems to occur when she hasn't slept well.  She has fainted twice minutes after having eaten.  I think somehow the lack of sleep is negatively affecting her blood pressure.  We've been to a cardiologist- no problems found.  Do you have any ideas?  Do you have any suggestions as to how to go about finding the reason?

Thanks,
Rosemarie
 

Dear Rosemarie --

Two thoughts, neither of them of great value I fear, as this phenomenon is not a well recognized pattern:

First, your observation connecting these fainting episodes to having eaten does strike me as important.  As you know, just as we used to be told by our mothers to avoid swimming after reading, a meal diverts blood flow to the gastrointestinal tract, so you could be right about blood pressure as the basis for these fainting spells.

Secondly, a friend of mine says “medications are guilty until proven innocent.  Although neither lithium nor divalproex (Depakote), commonly causes problems like this—I can say that with assurance because I have used them a great deal I have never seen this – , still one has to wonder if somehow, for your daughter, they are playing a role in this.  I would like to pick the more likely culprit but really I can’t think of a reason to suspect one more than the other.

I hope that by the time you receive this, as I am late this week, the problem has been solved or results.  If not, good luck getting it figured out.

Dr. Phelps



February, 2009