Expert: Ivan Goldberg, M.D. - 1/24/2009

Question
Dear Dr. Golberg,
My friend/Sandi(female-49)has daughter/Ali-22 being treated for pretty severe bipolar-1.  Sandi has been having increased episodes of depression & anger over past 3 yrs and sought treatment from same Dr. as her daughter.  She was given anti-depressants which helped a bit but shortly stop working.  Her older daughter/Stephanie-25 has been treated for social anxiety disorder from her teen yrs, but has recently also had bouts of depression/aggitation.  She was given anti-depressants, which (same as Mom) only helped for a short while.  She moved & met w/new Dr. who told her that if there is bipolar in the family, then it is highly UNlikely that there would also be depression.  He told her that she has bipolar-2.  Now of course Sandi is confused & wondering if she also has bipolar-2, which would explain why the anti-depressants aren't really working for her either. Is there research data indicating genetic connections on these conditions?  Is it more likely that Sandi & Stephanie have bipolar-2 or that they really could have just depression (even though Ali truly has bipolar-1)? I told Sandi about this wonderful website & promised to ask this question for her (as she doesn't have internet). I am grateful for your insite.

Answer
Hi Jayne. . .

I am not allowed to do anything that approaches making a psychiatric diagnosis via the internet. However I can say the following.

If I had a patient who:

1. had a family member diagnosed with any from of bipolar disorder;

2. had a psychiatric disorder that included depressive episodes;

3. had a response to antidepressants that was not full and long-lasting . . .

I would be VERY suspicious that a disorder in the bipolar spectrum was part of the problem.

You might do Google searches on the following two terms:

"soft bipolar"
and
"bipolar spectrum"

and send the results to Sandi

Best regards . . .

Ivan
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