Bipolar III?

Q: what is “type three” case of bi-polar?; Dr said it is rare
Dear Sue —
Bipolar III is not in the “official rule book”, but is used by mood
experts to refer to hypomania that emerges only when a patient is given an
antidepressant.  In my experience this is not at all rare, and prompts an
examination of the patient’s previous mood experiences to see if there is a
subtle Bipolar II in her/his history.  If it’s subtle enough, it may not
need treatment with mood stabilizers.  And since we usually use the same
threshold of severity of symptoms to: a) decide that a person merits a
“diagnosis”, and b) decide that she merits treatment — this means
that someone who does not merit treatment should not get the label
Bipolar II (since these labels carry a lot of unfortunate weight, in a variety
of ways). 
The point of all this is that some doc’s might call such a person — who has
some symptom history perhaps, but doesn’t merit a diagnosis — Bipolar III, if
she gets mildly hypomanic on an antidepressant. 
And the most important point: this person should watch out about taking an
antidepressant alone.  Wellbutrin seems to be the best tolerated
antidepressant in this situation, amongst the routinely used antidepressants
(i.e. least likely to precipitate hypomania). 
Dr. Phelps
Published February, 2001 Bipolar III? Q: what is “type three” case of bi-polar?; Dr said it is rareDear Sue —
Bipolar III is not in the “official rule book”, but is used by mood
experts to refer to hypomania that emerges only when a patient is given an
antidepressant.  In my experience this is not at all rare, and prompts an
examination of the patient’s previous mood experiences to see if there is a
subtle Bipolar II in her/his history.  If it’s subtle enough, it may not
need treatment with mood stabilizers.  And since we usually use the same
threshold of severity of symptoms to: a) decide that a person merits a
“diagnosis”, and b) decide that she merits treatment — this means
that someone who does not merit treatment should not get the label
Bipolar II (since these labels carry a lot of unfortunate weight, in a variety
of ways).  The point of all this is that some doc’s might call such a person — who has
some symptom history perhaps, but doesn’t merit a diagnosis — Bipolar III, if
she gets mildly hypomanic on an antidepressant.  And the most important point: this person should watch out about taking an
antidepressant alone.  Wellbutrin seems to be the best tolerated
antidepressant in this situation, amongst the routinely used antidepressants
(i.e. least likely to precipitate hypomania).  Dr. Phelps
Published February, 2001