Grief vs "soft" Bipolar 2
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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 people?

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 different angle.

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.

Dr. Phelps


Published June, 2010



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