Expert: Ivan Goldberg, M.D. - 12/25/2010

Question
I am a licensed MFT in California; I have been seeing a young woman for approximately 5 years, who suffers from anxiety and depression.  Her overall well being has improved 80% since she began therapy she had been prescribed Buspar, she said it helped her, and took it for almost 3yrs, she was doing so well she stopped and felt great.  She has seen 5-6 Psychiatrists in her life, and just recently due to some post partum depression had been on Buspar for about 6months, went to see a new Psychiatrist, whom she told she had been put on prestiq briefly after she gave birth, and had some mania side effects.  He told her after seeing her for the first time after 20 minutes, he was certain she is bipolar, and she should go on three medications just to be prophylactic , immediately.  He also said she should be aware that she would have a very serious major depressive episode in her life, and to be aware!   She left his office crying hysterically, and I told her I would do some research, to find if that were true or not.  Her Mother suffers from Bipolar, she has three sisters and one of her sisters is also bipolar, and she is the only one in her dysfunctional family (father was a raging verbally abusive alcoholic, died from alcoholism) that has been in therapy and goes to Alanon regularly, and seems to be doing very well in her life.
It is not in my scope of practice to give advice on medication, but I certainly am willing to challenge things I question.    I specialize in addiction, alcoholism, and family co-dependency, I am licensed for 20 years, and I have never heard of anyone diagnosing someone in such a manner, and then telling them he would not renew their prescription, and let them walk out of the office with no resolution.    
The bottom line question, can you diagnose Bipolar from a side effect of being hyperactive and have trouble sleeping on Prestiq, to say without any doubt the person is Bipolar?  He did say he was “certain”  she was bipolar. I have suggested she get another opinion from another psychiatrist in her area.
Thank you for taking the time to read this and answer my question.

Rose Safran

Answer
Hi, Rose . . .

Hypomanic or manic symptoms induced by antidepressants are excluded by the DSM-IV from making a diagnosis of bipolar disorder. While this is the official rule, most of us who have a lot of experience identifying patients with the more subtle form of bipolar disorder believe that such antidepressant-induced symptoms are the most sensitive indicators of at least a touch of bipolar disorder.

If I had to bet, based on the family history, and the response to Pristiq, I estimate that there is about a 70% chance that your patient has a mild form of bipolarity. This "soft bipolar" disorder, or "bipolar spectrum" disorder is as different from classic manic-depression as a common cold is from double pneumonia. You might want to Google the two phrases in quotation marks.

Best regards . . .

Ivan
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