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Re: What do you guys think about Dr. Phelp's Site? » spike4848

Posted by Cam W. on December 21, 2001, at 0:36:19

In reply to What do you guys think about Dr. Phelp's Site?, posted by spike4848 on December 20, 2001, at 18:42:46

Spike - I think Dr.Phelps has overblown the situation a bit. What he is saying about many depressions actually being bipolar II has been known for quite a while. I'm fairly sure that we have talked about it on this board.

I had supper with Dr.E.Roy Chengappa, from Case Western in Pittsburgh, one night a couple of years ago. He had given a group of pdocs (and me) a talk on Topamax's use as a mood stabilizer. He was saying that he thought that the increased incidence of bipolar disorder since World War II was due to the discovery of antidepressants, especially the MAOIs and TCAs. These two classes of antidepressants have a fairly significant "manic switch" rate.

Today's newer generation do not seem to cause manic switch as readily, although it happens in about 5% of the time. I Phelp's figure of 40% is correct, this means that SSRIs, SNRIs, bupropion, etc. will cause manic switch in bipolar patients only about half the time.

I really don't think that the figure is as high as 40%, but if it is, there are a lot of mild cases out there. I don't know if it would be worth the side effects and risk of hepatoxicity to put everyone who is depressed, on divalproex (Epival™ or Depakote™) or risk a life-threatening rash with lamotrigine (Lamictal™) before trying an antidepressant.

I have seen a lot of people treated with antidepressants (literally hundreds), but I have only 2 cases of manic switch. I know that there are more than I see, but you'd think I would at least here about during "shop-talk" with the pdocs.

Yes, doctors should diagnose more carefully, but diagnoses, especially subtle ones, are easily missed. - Cam




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