Expert: Ivan Goldberg, M.D. - 7/13/2009

Question
Dear Dr. Goldberg,

I had previously been diagnosed first as major depression, and then bipolar II, but had questioned the diagnosis because when I was on all of the antidepressants and mood stabilizers, I got much, much worse and very suicidal.

Background:  Started getting depression as a teenager, and when I was pregnant with my 2nd child, I had terrible post partum depression.  I had several more rounds of depression over the years (I'm now 44 years old).  About 5 years ago when I was referred to a psychiatrist for my depression that wasn't responding to antidepressants, this doctor decided that I was bipolar II (even though I have never had a hypomanic episode).  I then had mood stabilizers added to the antidepressants.  I would never improve and got much worse, and over the next 2 years would end up hospitalized 7 to 8 times because of suicidal thoughts, plans, or attempts.  I also had 3 or 4 rounds of ECT.  This was devastating to me and my family.  I kept asking the doctors how could I be bipolar if I kept getting worse on the different medications that they were having me take, but no one had an answer for me.

I finally decided on my own to very slowly wean myself from all of the different medications that these doctors have had me on (over about a 7 to 8 month period), and since I have been off of these drugs I am no longer suicidal nor have I been hospitalized.  I do take multi-vitamins along with fish oil, and I think that the fish oil has helped my depression some.

But, I still feel that I am not a "normal" person.  I still have a very hard time keeping a job because I either have way too much stress or get upset the way the company is run (no ethics, for example).  Right now, I have so much stress at my job because I can't handle the strange woman I work with, and I also feel that my direct boss is monitoring everything that I do but I don't do anything wrong.  I feel I'm being harassed by these 2 people, and also because this is the earliest I've had to get up for a job (5am) I am not getting enough sleep.  The stress also contributes to my lack of getting enough sleep (about 4 to 5 hours a night), and I am so irritable because of it.  I have been looking up the definition of "racing thoughts", but I don't think that I have them, I just have a very active mind that's hard to turn off that also contributes to me not getting to sleep (I have had this off and on as long as I remember, the more stressed I am, the worse it is).  I do think that I may have some of the signs of BP II, but I am afraid to take any medication after what I went through before.  

I have called and made an appointment with a new psychiatrist, because of my job, and I will be seeing him this Friday.  I asked him on the phone that if he does think I'm bipolar if I have to take antidepressants, because I think that they made me extremely depressed in the past, and he said that they can make bipolar patients go into mania.

Can taking mood stabilizers alone without antidepressants make a person very depressed and suicidal?  If a person takes these mood stabilizers and they don't get better, does that mean that their not bipolar?

I would appreciate any insight that you would be willing to give to me.

Thank you.

Answer
Hi, Sandy . . .

Obviously it is not possible for me to make a psychiatric diagnosis based on the information contained in your query. I think the idea of your seeing a new psychiatrist for an evaluation is a good one. When I see people for such evaluations I insist that the person being evaluated bring a good friend or relative with them to the evaluation as I find that getting the "outside story" from the friend or relative in addition to the "inside story" from the patient allows me to do a better evaluation.

At the end of your query you ask two specific questions:

1. Can taking mood stabilizers alone without antidepressants make a person very depressed and suicidal?  

and

2. If a person takes these mood stabilizers and they don't get better, does that mean that their not bipolar?

The answer to your first question is that increases in suicidality have been reported with the anticonvulsant mood stabilizers such as Tegretol;, Lamictal, and Depakote. The F.D.A. has recently required such warnings to be included in the labeling of such drugs. Please see: http://www.nytimes.com/2008/02/01/us/01suicide.html

The answer to your second question is that the failure to benefit from the mood stabilizing activity of so called "mood stabilizers" does not rule out the possibility of one having a form of bipolar disorder. Unfortunately, our treatments are not so uniformly effective that the failure to get better when treated does not mean that the bipolar diagnosis is wrong.

Best regards . . .

Ivan
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