Posted by Sulpicia on June 7, 2001, at 1:06:27
In reply to Re: Wellbutrin and bipolar syndrome, posted by Joanna on June 6, 2001, at 11:12:08
> > Absent further info, without established mood stabilizer, wellbutrin is likely to set off mania.
> > S.
>
> Whoopee. Dr Doofus strikes again...
You should copyright that -- it made my day. How true too often.First, I'm not a professional. There are 2 answers to your question actually.
If he is not impaired by bp, it gets dicey recommending pharmacological intervention.
Most people with bp get into serious trouble with their moods: mania can involve spending
huge amounts of $$, promiscuous sex, delusions -- you know, the kind of behavior that
tends to attract NOTICE and consequences. Ditto for the lows: the depression can be crippling.
And it's nearly universal to love the productive and creative potential of the highs. With hypomania
only and relatively mild depression, a patient or a pdoc might consider mood stabilization overkill.
The drugs work to be sure, but they are not without side-effects, and finding an effective one and its
proper dose can be torturous.
On the other hand, bipolar has an 18% mortality rate -- that's roughly the same risk of
dying that you'd have if you caught a localized malignancy in your breast early. While your friend
has a *reason* for being depressed, not everyone who is twice bereaved in rapid succession takes an AD.
Something must have motivated this.
The real problem with not trying to achieve mood stabilization is a phenomenon called "kindling." I'll
have to hunt down the references for you -- and I'm already late finding refs for another person [shame], or
how are you at using Pubmed??
The point as I remember it is that the cycling of bipolar feeds on itself and gets stronger over time: it's
sort of like diabetes and blood sugar -- you want to keep things on as even a keel as possible.
How much does your friend know about bipolar? Who had it in his family?
And now as I re-read your last post, I do see a progression. Perhaps he sees this in his mood charts?
Some education and info might motivate him to try mood stabilizers, especially since the newer ones don't
have so many side-effects.The other possibility, if he refuses pharmacology, is to suggest he look at Andrew Stoll, MD "The Omega Solution" --
the title may be incorrect but his name should pull it up on Amazon.com
Stoll was able to demonstrate that a specific supplement of essential fatty acids helped bipolars prevent relapse, ergo
cycling and destabilization.
The downside is that all the bipolars were on mood stabilizers -- nobody stopped meds. The supplements were an adjuvant
however fabulously successful. There is absolutely NO evidence that EFAs work alone.
NOW THIS IS IMPORTANT: these supplements are essential fatty acids distilled from fish oil [in capsules, don't panic]: the 2
bioactive substances are EPA and DHA. People with bipolar must take a supplement with A RATIO OF EPA TO DHA OF AT LEAST
3EPA TO 1DHA. One of the earliest discoveries about these supplements was that DHA given with insufficient ratio of EPA
plunged bipolars into severe depression.Perhaps this is something he could explore with a pdoc -- other than Dr. D. -- it would be ideal if he
were to educate himself about bipolar with a pdoc's help. Then perhaps he might be more willing to accept
pharmacological intervention.
Would he like to lurk at a good bipolar forum?
he might benefit from reading the posts at:
http://neuro-mancer.mgh.harvard.edu
he should then select the bipolar forum from the list.I'm not sure what else to suggest. It's disquieting to think that he'd be untreated
until all hell breaks loose.
He's lucky to have a friend like you.
Liz
poster:Sulpicia
thread:65495
URL: http://www.dr-bob.org/babble/20010605/msgs/65628.html