Diagnosis and Treatment of Bipolar Disorder - Bipolar Treatment

Written by HealthyPlace.com Staff Writer

David: Here are some more audience comments on what treatment worked best for them:

Farfour: Nothing yet.

thelma: Shock treatment, Lithium (it was toxic), Prozac, Zoloft.

shineNme: Depakote, Eskalith and Vivactil have helped, but not totally eliminated the depression.

bernadette: Lithobid 1200 mg daily.

jeckylhyde: Depakote. My manics have been kept in check, but I can't find relief from the depression.

shineNme: Before I was treated I was very promiscuous, I was a overly happy manic then.

Mongan: Depakote worked, but had to keep upping it. Lithium works OK, but nausea persists.

Karen2: How many years must Lithium be taken for Bipolar?

Dr. Fieve: Karen, for active manic patients, generally in the patients I have treated the correct dosage of Lithium brings them down to normal within ten to fifteen days. If depressive swings follow and the Lithium level is sufficiently therapeutic, .7 to 1.2, then an antidepressant has to be added. This is basically the art of treatment of the individual of the psychopharmacologist who has seen many patients; often atypical and often with complications over time.

JAMBER: How do you know if your child has ADHD (Attention Deficit Hyperactivity Disorder) or Bipolar?

Dr. Fieve: Jamber, often you do not know, and only the factor of time will reveal which of these two diagnoses is the correct one. Do not put labels on these young children too early since many emotional problems, personality disorders, etc., disappear as children get older, and often it is the parents' anxiety that must be addressed. However, children with serious problems must be evaluated and followed by experts, but diagnostic labels should be avoided if possible. Trials, which are exploratory, and time-limited medications can be undertaken with disturbed children. But unless the patient improves, these medications should be indefinitely given. A very understanding therapist is critical for these young people, who are undergoing constant physical, emotional, and environmental changes.

eirrac: Do children, who will eventually develop bipolar in later years, exhibit any behaviors early on that might predict the illness?

Dr. Fieve: They may exhibit hyperactivity, high energy, distractibility, charm and accomplishment. Or they may experience nothing that you can detect. They also may experience sadness, withdrawn behavior and poor socialization.

Jocasta: I was quite taken with your book "Moodswing". I am interested on your current opinions of alcohol use and the combination with antidepressants and Lithium and benzodiazapines. I read your book in 86'. What are the effects on moderate OR binge drinking NOW in 2000, with concurrent use of alcohol or SSRI's and lithium? What is also the preferred SSRI of choice with the least sexual side-effects? Serazone? Zoloft is great but, seems to strike out at high levels. Paxal? Help please, Sir.

Dr. Fieve: Jocasta, there are three or four questions to answer.

David: Why don't you address the alcohol use since I've received several questions about that.

Dr. Fieve: There are no studies that Lithium and/or antidepressants make a difference in moderate to severe alcoholism or binge drinking, even though one study 22 years ago suggested Lithium helped in binge drinking, but this was refuted by another study later. The alcohol itself must be treated as an illness with abstinence and preferably AA (Alcoholics Anonymous), and thereafter, if manic depression is an accompanying co-morbid illness, it can be treated with an antibipolar drug and therapy. If you have no alcoholism in your past history or family history, I prescribe a very modest amount of alcohol, like a glass of wine at dinner, if the bipolar illness is stable. Other doctors might object to this since alcohol and bipolar are genetically related and they fear any alcohol becomes a deterrent in treating bipolar illness. I don't, since the patient's overall quality of life must be maintained if at all possible with a minimal risk. The drugs with the fewest sexual-side effects (antidepressant) include Serzone, Wellbutrin, and possibly Remeron and maybe Celexa.

Nancy Smith: Is the diagnosis of bipolar often used when a teenager is really just antisocial or delinquent? (Not that antisocial behavior isn't a serious problem!)

Dr. Fieve: Nancy: It is possible, if you are going to an inexperienced doctor/psychiatrist/teacher who has read a lot about bipolar in the newspapers or magazines that are current, that this could occur as a simple label to explain this behaviour.

David: Well, it is getting very late. Dr. Fieve, thank you for being here tonight. You were a wonderful guest and we appreciate you sharing your knowledge and insights with us. I also want to thank everyone in the audience for coming and participating. I hope you found the conference helpful.

Dr. Fieve: It was a pleasure to participate in this stimulating discussion with your audience, and congratulations on developing and moderating such an educational force in the community.

David: Thank you doctor, and we hope you'll come back again in the not too distant future. Here are the links to Dr. Fieve's books: "Moodswing", and "Prozac". And here's Dr. Fieve's website: www.fieve.com.

Dr. Fieve: Thank you, and I would be very pleased to return - GOODNIGHT.

David: Good night everyone and thank you again for coming.

Disclaimer: That we are not recommending or endorsing any of the suggestions of our guest. In fact, we strongly encourage you to talk over any therapies, remedies or suggestions with your doctor BEFORE you implement them or make any changes in your treatment.

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