Maura asks…

Hi Dr. Fink. My husband of 30 years has just been diagnosed “possible Lexapro-induced hypomania/possible true BPD” After a very difficult and abusive childhood with alcoholic parents, he has been seasonally depressed as long as I have known him. Usually starting around November, and not clearing until late spring.

Although fully functional, he was having somatic complaints and once, an episode of chest pain severe enough to take himself to the hospital for evaluation. Two years ago, he agreed to begin treatment with our family PMD for his depression and did EXTREMELY well mentally on Zoloft 150 mg. He stayed on Zoloft for a year but reluctantly changed to Lexapro 20 mg. qd, due to severe, unremitting heartburn with the Zoloft.

October 13, 2010, J.K. Wall of the Indianapolis Business Journal posted an article entitled “IU Shrink explores mental health blood tests.” According to Wall:

“Dr. Alexander B. Niculescu, a psychiatrist at the IU School of Medicine, has won a five-year, $1.5 million grant from the National Institutes of Health to hunt for the presence of certain proteins in the blood that would indicate that a person suffers from a mood disorder, which afflicts one in five Americans.”

A blood test for bipolar disorder is one of the holy grails of psychiatry right now. Patients often ask me if there is such a test, and unfortunately, as of now, no such test exists. Even with ongoing research, it will be a very long time before a blood test is a realistic part of everyday clinical practice.

A Science Update published by the National Institute of Mental Health (NIMH) entitled “Imaging Studies Help Pinpoint Child Bipolar Circuitry” reports the results of recent brain imaging studies that reveal that “…the brain works differently in youth with bipolar disorder (BD) than in chronically irritable children who are often diagnosed with pediatric BD.”

According to Ellen Leibenluft, M.D., chief of NIMH’s Section on Bipolar Spectrum Disorders, which is conducting the studies, “This suggests that chronically irritable children may suffer from a syndrome distinct from BD and may require different treatments.”

This particular article draws some very useful distinctions among the following three diagnoses:

In Part I of this two-part series, I discuss the differences between bipolar and borderline personality disorder in terms of diagnosis. In this part, I focus on differences in treatments for the two conditions.

Treating Bipolar Disorder

Bipolar disorder has been considered a biological illness for many years, and the research has focused largely on medications. A standard repertoire of medications is used to treat bipolar:

Bipolar disorder and borderline personality disorder often share many of the same symptoms – mood shifts, emotion dysregulation, impulsivity. In “Is Bipolar Disorder Overdiagnosed in Adults?” I cited a study suggesting that a number of people diagnosed with bipolar disorder actually meet criteria for borderline personality disorder, instead.

So what’s the difference? It’s a complicated discussion. Although some overlap may exist, important distinctions separate the two conditions, yet some researchers believe both conditions are likely a part of a continuum and are, in fact, related to one another.

In this part of a two-part series, I highlight the diagnostic differences between bipolar disorder and borderline personality disorder. In Part II, I focus on differences in treatment for the two conditions.

Development/Nature of the Illness

Borderline personality disorder is a type of “personality disorder” which essentially means that it is a developmental condition – something that has evolved through the entire development of a person’s emotional/behavioral infrastructure.

May asks…

I’m wondering if any research has established a link between patients with Bipolar Disorder I or II and nervous system disorders? I’ve suffered from different types of neuralgias for years, as well as IBS and migraines. One of my doctors said she often sees these or similar co-morbidities, but she’s not sure why.

Chronic pain combined with a mood disorder does not make for a very pleasant life. I recently read somewhere that people with chronic pain tend to carry a lot of stress and tension, both physically and psychologically, much like BP sufferers do.

There has been a lot of discussion about the over-diagnosis of bipolar disorder in kids, but what about in adults? In the wake of increased bipolar awareness and vigilance, are doctors mistaking other disorders or even excessive irritability and anger as bipolar disorder? If the doctor has a hammer, does everything start to look like a nail?

Researchers in Rhode Island have looked at this specific question and found evidence of a pattern of over-diagnosis of bipolar disorder in adults. In a study published in 2008, Zimmerman and others reported that out of a group of 700 patients who had previously received a diagnosis of bipolar disorder, fewer than half met the criteria when given a more comprehensive psychiatric evaluation.

Deborah asks…

Can overlooked hyperthyroid be misdiagnosed as bipolar for years before it’s recognized as the problem?

Dr. Fink answers…

Good question, Deborah. Yes, as we point out in Bipolar Disorder For Dummies, the thyroid gland has a tremendous influence on moods and on the effectiveness of medications used to treat mood disorders. Other physical ailments can also produce or contribute to bipolar-like symptoms in a person who does not have bipolar disorder.

Psych Central Senior News Editor Rick Nauert PhD recently posted an article entitled “Test for Genetic Risk of Bipolar,” calling attention to researchers from the Indiana University School of Medicine who have developed a test (prototype) for identifying a genetic susceptibility to developing bipolar disorder.

It’s important to keep in mind that this is not simple blood test to determine whether someone has bipolar disorder. It merely helps predict who may be at risk for developing bipolar if environmental conditions for developing bipolar are also present.

Sharon asks…

If you are a bipolar who has never had a manic episode but experiences only depression, how is that different from plain old depression? How does a doctor or clinician make the diagnosis? I ask because I started on Prozac in 1993 and had a phenomenal positive reaction, which lasted a number of years until it finally wore off. I tried, with a psychiatrist, many different anti-depressants (though not tricyclics) and nothing worked, until finally he gave me Lamictal (lamotrigine) and Prozac (fluoxetine). This has worked very very well for me for about a year (knock on wood), but I never considered myself bipolar, only depressed. Just curious if there’s any neurological difference anyone knows of.