Expert: Ivan Goldberg, M.D. - 3/7/2005

Question
BACKGROUND:My 44-yr-old daughter has been ill for 20+ years; is bipolar, primarily depressive.  In fact, has never been manic, tho hypomanic. Mostly exhibited, in recent years, agitated depression. Long depressions are a thing of the past.  Disabling depressive episodes are v short, perhaps 2-4 days.  She is able to do voluntneer work, take classes, drive, live independently. Current meds are lithium, lamicatal, effexor and, since mid-Dec '04, GEODON.
The GEODPN has had miraculous effects and has restored much of the personality lost for so many years.  It has improved her confidence, competency, her failing cognitive abilities, abililty to cope, to make decisions. She is usually pleasant now, congenial, and her own cheerful relaxed self.  She has become thoughtful of me, during a recent short illness, calling when out to see if anything was needed.
Alas, the breakthrough depressions continue but, tho they are equally painful to her [I have inquired], her mood w/ others, WHILE depressed, is much different...no anger, etc.
SO, WHERE IS THE PROBLEM?  DOC IS THE PROBLEM.  I was horrified to learn that Doc is trying has labled all this good stuff as mania/hypomania and as evidence that she is still rapid-cycling!!!!  He wants to get rid of it/Her!  His argument: one goes from depressed to not-depressed, not to feeling good.  Daughter and I think: you go from depressed to own-normal self, whatever that may be and, w/ Geodon, it is not a down-trodden, symptomatic self, but a "normal 'Normal'" self.  Doc says, nope...you can only go from Down to YOUR OLD PRE-GEODON BASELINE.
Would very much appreciate your opinion.

Answer
Hi . . .

There is no way that I can answer your question. Without examining your daughter at various points over a number of months there is no way that I can determine if she is euthymic (normal or hypomanic when she is not depressed.

You may want to seek a second opinion from an expert psychiatrist who can examine your daughter at various points in her cycling. A list of such psychiatrists may be found at:
http://www.psycom.net/depression.central.psychiatrists.html

Best regards . . .

Ivan
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