Is There Any Way This May Not be Bipolar Disorder?
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Q:  Is There Any Way This May Not be Bipolar Disorder?


My doctor (psychiatrist) says I have a low level form of bipolar disorder.  My symptoms were insomnia, irritableness, and a feeling I can best describe as "climbing the walls" or "grinding" inside.  Any hint of depression was very miniable and related to the frustration of not being able to get past the first feelings I described.  The doctor put me on depakote and neurontin and I have to say that the symptoms have gone away.  I recently started taking 6 grams a day of Omega-3 Fish Oil (Costco brand).  Is there any way that this may not be bipolar disorder?  All of this is important to me as a private pilot because the FAA will absolutely not certify me medically to fly with a bipolar diagnosis of any kind.

Thanks!

Dear S’ --
Thanks for your question. There are probably lots of people out there like you, whom we psychiatrists never see – extrapolating from what we do see, which is an entire range of severity from extreme (psychotic and suicidal) to minimal (interferes with high level performance but otherwise unnoticeable to anyone but the owner).

On that basis I’d presume that many people experience something that might be construed as “symptoms” in one context but just as an unfortunate aspect of personal experience in another context (e.g. “I’m just such a terrible sleeper”; or “sometimes I just can’t settle myself down and get my work done, I just have this grinding feeling inside and all I can do is go for a walk or listen to Mozart”; something like that).

In any case, you’re a good example of why our psychiatric naming system is unfortunate. You don’t have “bipolar disorder” in any way resembling the full manic-depressive syndrome we’ve been treating for years with lithium. But if your doctor is correct you might have a very mild version of something related. 

For years the hunt was on for the “gene” for bipolar disorder, hoping there was one, like the gene for Huntington’s Disease (a much more rare mental health malady). But in the last decade it’s become clear that there is no single gene for bipolar disorder; indeed there may be a hundred or so genetic factors that affect susceptibility (and resilience) to mood/energy disturbances that when extreme we recognize as “bipolar disorder”. Imagine how many different forms of mood/energy problems could be created from mix/match combinations of that many genes. Yet to use the same name for the mild forms, just because we think that the mechanism might be similar, leads to problems -- such as with the FAA.

A label we sometimes use under these circumstances is “Anxiety NOS (not otherwise specified)”, which it sounds like could be accurate (i.e. by your account here you may not meet diagnostic criteria for any version of bipolar disorder per se), if some diagnosis needs to be reported for you. Your psychiatrist has to put something on the billing sheet for the insurance company and the laboratory when you have a blood test.  I don’t know how the issue will arise with the FAA.

You seem to be wondering whether by taking omega-3’s you might be able to get off the divalproex (Depakote) and gabapentin (Neurontin). For very mild symptoms that might be plausible (though of course you’d do this in direct discussion with your psychiatrist). Unfortunately for people with substantial symptoms, I’ve not seen any be able to get full symptom control with fish oil alone (exercise alone, sometimes; maybe a combination of the two, perhaps). So be careful when/if you start tapering something. Good luck with the process from here –

Dr. Phelps



Published January, 2010

 

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