Q: Grief vs "soft" Bipolar 2
Hello Doctor Phelps- I became very attached
to my partner of 6 years...he always knew how to sooth my low grade anxiety and
calm my nerves. After our relationship ended the grief and depression appeared.
I could not seem to self regulate after our separation. After trying alternative methods(psychotherapy, yoga, meditation, balanced eating)for 15 months, I
finally visited with a psychiatrist. To my surprise, he diagnosed me with soft
biploar 2. He noticed mild hypomania in my speech and a tangential thinking
process. He also reminded me that I have a family history of mental illness.
Finally, my question for you- Since I have only experienced depression with life
events(ie. two relationship break ups)....could this mean that I do not have
soft bipolar and I am one who hangs out in the grief phase longer than most
Dear Katie --
An understandable question. As it you may have
begun to suspect, the answer may lie in considering the difference between the
two explanations, and examining how you might approach "treatment" in each case.
In other words, think about how you would approach
this problem if you decided that you are a person who hangs out in the grief
phase longer than most people. 15 months is a mighty long time. But if you had
the sense that you are slowly working your way out of it, you could try waiting
it out. You've clearly tried to find things that might help, and perhaps using
all of the things that showed at least some slight evidence of benefit, all
together, might help you slowly regain your equilibrium.
On the other hand, if you did indeed have "bipolar
II", however soft, you might consider a medication approach like lamotrigine
(which I think most mood experts are now regarding as the best starting point
for that condition is a pharmaceutical approach is to be used).
In between there are probably several other
strategies, such as omega-3 fatty acids from fish oil at the full treatment
doses used in previous research studies first; as well as other forms of
exercise, and other kinds of psychotherapy which approach your symptoms from a
Once you have laid out a full array of treatment
approaches you might consider, from one extreme to the other, you might want
simply to choose from the treatment options rather than stress too much about
exactly what diagnosis you are treating. As you can see, many treatment
approaches would be appropriate regardless of how you label it.
In my opinion, the biggest issue arises when
considering whether or not you should try an antidepressant. Recent evidence
suggests that people with bipolar II can do pretty well on antidepressant, at
least one exposed to it for the first time, and perhaps for only a relatively
brief time. On the other hand, many mood specialists, including me, think that
using one at all may carry unappreciated risks (here is my whole shtick on that:
Antidepressant Controversies) and besides, we have numerous alternatives (9
antidepressants that are not antidepressants).
I hope that might help you in your discussions with
the psychiatrist Re: how to proceed at this point. Good luck with that process.
Published June, 2010