Expert: Ivan Goldberg, M.D. - 6/8/2008

Question
QUESTION: my husband has been recently diagnosed (at age 52) with soft bipolar.  Sometimes he would rage over stupid things and we would bear the brunt of it.  He never had the high feelings, only low and being critical of all others.  Now the doctor has given him wellbutrin xl.  
How well does this medicine work on people with these systems.  I am hoping that once he sees his life as a good one, his rage and outbursts will deminish and my children will not live in fear of it.

ANSWER: Hi, Marie . . .

The use of antidepressants alone in people with any form of bipolar disorder sometimes leads to a worsening of anger and irritability. I often treat such people with mood stabilizers (such as lithium and/or Lamictal) first, and only when they don't work, will I add an antidepressant.

Best regards . . .

Ivan
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---------- FOLLOW-UP ----------

QUESTION: Is rage and depression part of soft bipolar?  I can honestly say my husband has never felt a day has been great, or even if he does when he looks back at his life, he says it has always been "a job."  I thought bipolar meant that they had high and lows, instead what I see in him is low and anger, which turns to rage and hostility, almost as if the children (17, 13 and 10) are the cause of his life's hardships.  Almost as if he is in a box, and required to take responsibility, regardless of what he wants.  I have seen him turn to alcohol to make him feel better.   Does this sound like bipolar.  I thought it sounded more like depression.  If there are no "highs," then how does family know it is bipolar?

Answer
Marie . . .

A common mistake in thinking about people who have some form of bipolar disorder is to think that they have some times when they are depressed and other times when they are happy or euphoric. There is something known as "dysphoric mania" ( Google it to get many details) in which the manic parts of the disorder are irritable, angry, and sometimes paranoid. People with dysphoric mania often think of themselves having 2 kinds of depression, a more calm kind of depression, and a more angry/irritable sort of depression.

I hope this helps.

Best regards . . .

Ivan
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