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Diagnosis and Treatment of Bipolar Disorder

Dr. Ronald Fieve: is a widely recognized authority in the treatment of bipolar disorder and author of the books "Moodswing" and "Prozac". He is a specialist in diagnosing and treating bipolar disorder.

David: is the HealthyPlace.com moderator.

The people in blue are audience members.


online conference transcript

David: Good Evening. I'm David Roberts. I'm the moderator for tonight's conference. I want to welcome everyone to HealthyPlace.com. Our conference tonight is on "Diagnosing and Treating Bipolar Disorder". We are fortunate to have a great guest, Dr. Ronald Fieve.

I'm sure many of you have heard of Dr. Fieve. He is the author of the best-selling books, "Moodswing" and "Prozac". He's widely recognized as an authority in the treatment of bipolar disorder. In addition, Dr. Fieve operates one of the largest clinical trial centers for new antidepressants coming on the market.

Good Evening Dr. Fieve and welcome to HealthyPlace.com. Thank you for agreeing to be our guest. Because our visitors have different levels of understanding, could you please define what bipolar disorder, manic depression is?

Dr.Ronald Fieve, bipolar treatment expert and author of Moodswing and Prozac, discusses diagnosing and treating bipolar disorder. Read transcript.Dr. Fieve: It is classified by the American Psychiatric Association, using the research criteria of the diagnostic and statistical manual (DSM4), as a major, and one of the world's major, mental illnesses characterized by mild to wild swings in mood and behaviour, going from elation to depression.

David: From the conferences that we've held here, one thing I've come to understand is that some psychiatric illnesses are difficult to diagnose. How is bipolar diagnosed?

Dr. Fieve: There are no biochemical blood tests used to diagnose bipolar illness, like there is to diagnose diabetes and other medical conditions. It is diagnosed by a psychiatrist, psychopharmacologist expert, preferably using the DSM4 criteria, and taking an extensive family history and personal history of the patient's mood and behavior over his or her lifetime.

David: And because there are no tests, per se, is that why some people, over the course of their lifetime, can be diagnosed with, let's say, ADHD (Attention Deficit Hyperactivity Disorder) and later the diagnosis is changed to Bipolar?

Dr. Fieve: Yes - an expert in the fields of these two illnesses, most often can distinguish between the two and make the correct diagnosis. Of course, the two illnesses can exist in the same patient which I have at times seen, requiring treatment for ADHD and bipolar at the same time. ADHD generally comes on in the very early years of childhood and early teens, where bipolar comes on in the early to mid-twenties, but there is no fixed rule for this. When in doubt as to the diagnosis, the family history of bipolar is very helpful in clinching the bipolar diagnosis in the patient, and leading thus to the primary treatment for bipolar instead of putting the patient on Ritalin for ADHD. ADHD is much harder to diagnose, and much less is known about it. And Ritalin, of course, is addictive, unlike the anti-bipolar drugs, which in adults is safer for a first trial, if the diagnosis remains in question by an expert.

David: I imagine it must be more difficult to diagnose children with bipolar than it is an adult. Is that true?

Dr. Fieve: Of course, YES. I would be very careful about it, but less so if there is a strong family history of bipolar, suicide, alcohol, great achievement, or gambling.

David: Is bipolar disorder genetically based, and is it hereditary?

Dr. Fieve: Yes. Genetic studies of bipolar illness, many of which I have participated in at Columbia Presbyterian Medical Center, show that bipolar illness is predominately a genetically inherited illness. It has a spectrum of manifestations in the children and relatives including depression alone, alcohol, suicide, gambling, great achievement and bipolar illness, like I said above. Genetically, we say that there is a gene-gene and a gene-environmental interaction, so that not 100% of bipolar can be considered genetic. We also call it a multifactural genetic illness.

David: Here are some audience questions:

michelle1: My boyfriend and I are both bipolar. Would you recommend us not to have children of our own?

Dr. Fieve: I would recommend that you make a decision based on the knowledge of all the facts and a few visits with a genetic counselor who is an expert in this field. After all is said and done, the genetic counselor can only give you statistical likelihood in percentages, and no-one can tell you that you absolutely won't have one, two, or three, perfectly normal children. It is simply that your risk of having a bipolar child is higher than if only one of you had it. And it would be lower still, if none of you had it. Don't try to outguess God and make you own decision based on the facts. The likelihood is higher than if only one of you had it, but as you know many people with bipolar illness are the movers and shakers of the world and make great contributions to the arts, science and business.

Hayley: I am 13 and my father is bipolar, he was also a alcoholic, and he is trying to get better. I hate how he acts and how my mom always talks about it with other people on the internet in the bipolar chatrooms, so I get mad at her. How can I help my dad and make my mom stay off the chat. It hurts me that she talks about it.

Dr. Fieve: You need two things: a father who is motivated to change via the correct treatment, and a psychiatrist who is an expert in the field and who will treat him. Many motivated people cannot find a bipolar expert, and many bipolar experts simply don't see the patients who need them and would benefit by their knowledge and treatment skills. Your mother should get him to a board-certified psychopharmacologist, preferably University affiliated, for an initial consultation and then go from there. And hopefully your father will go.


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Last Updated: 31 March 2017
Reviewed by Harry Croft, MD

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