Dr. Bob's Psychopharmacology Tips

Possible indications of bipolarity

From: rdb@icu.com (Richard David Brand, MD)
Date: Fri, 16 Feb 1996 13:31:10 -0500
Subject: Possible indications of bipolarity

I am thinking [a patient] may be bipolar, despite the absence of a clear manic or hypomanic episode, and may try valproate. Leading me toward the change in dx are the following:

• selectively better response to venlafaxine
• age of onset (too young to have recurrent unipolar depression)
• at least on SSRIs, a very rapid switch to euthymia (which for him may actually be hypomania, since his general character is depressive by nature).

From: LJGROLD@aol.com (L.James Grold M.D.)
Date: Fri, 16 Feb 1996 20:40:31 -0500
Subject: Possible indications of bipolarity

I have come to the same conclusion on several patients with recurrent depressions starting in adolescence. I also have found in such patients that venlafaxine and buproprion with a mood stablizer like divalproex to be very helpful in smoothing out the moods and in preventing more cycles.

From: rdb@icu.com (Richard David Brand, MD)
Date: Sun, 18 Feb 1996 14:01:22 -0500
Subject: Possible indications of bipolarity

Why does a better response to venlafaxine indicate bipolar tendencies?

--Andy Cheshire

Date: 29 Feb 96 19:33:28 EST
From: "Kip Doran M.D." <74444.3204@compuserve.com>
Subject: Possible indications of bipolarity

I often find that patients who truly have a robust response to an antidepressant in just a few days often turn out to be bipolar.

From: PMBrig@aol.com (Peter M. Brigham, MD)
Date: Thu, 29 Feb 1996 08:08:38 -0500
Subject: Possible indications of bipolarity

I have the growing impression that rapid responders who then lose efficacy despite subsequent dose increases often turn out to have occult bipolar disorder and respond when mood stabilizers are added. In retrospect I have come to think in some cases that the rapid initial response was a mild hypomania.

Date: Thu, 29 Feb 1996 11:03:35 -0400
From: scole@world.std.com (Stanley Cole)
Subject: Possible indications of bipolarity

This has been my experience too, that a number of patients with rapid response to SSRIs have ultimately gone on to get worse, appear to be hypomanic and eventually do well with added mood stabilizer. I have had one patient this year who had a remote post-partum depression, a number of successful courses of Prozac over the years, and only this past time demonstrated the picture described above. In fact, after she was stabilized, she wanted to do the experiment of going off the mood stabilizer and eventually demonstrated need for it.

Date: Thu, 9 Jan 1997 18:45:52 +0900
From: fukuda@med.teikyo-u.ac.jp (Rimmei Fukuda)
Subject: Possible indications of bipolarity

At 21:13 97.01.06, Ivan Goldberg wrote:

Among the possible indicators of some degree of bipolarity are:

• hypersomnia when depressed
• winter intensification of depression
• family hx of bipolar spectrum disorders
• profound lethargy when depressed
• irritability as a response to antidepressants
• "mini-hypomanias" -- seldom reported by the pt, but often by significant others, if asked.

Clinically I often see many, many of these typically young, mildly dysthymic, not necessarily suicidal, apparently functioning patients with histories of possible hypomania. They are sometimes with conflicts of identity and of human relationship and need psychotherapy or cognitive changes. The worst thing is to medicate them with too much long-term, short-acting benzodiazepine!

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