The December 20 issue of TIME magazine has ten questions with writer-actress Carrie Fisher, author of Wishful Drinking. One of the questions, from Gary Bebout of Los Angeles, asks:

What is the biggest misconception about bipolar disorder?

Fisher responds:

The big thing happening now that seems bizarre is that they’re diagnosing everyone with it. Anyone with a mood: Oh, they’re bipolar. We’re probably the most medicated society in the world. But misconceptions, I don’t know. We’re good dancers. All of us.

How would you answer this same question? What do you think is the biggest misconception about bipolar disorder?

Carla asks…

My son was in nursing school, age 27, and working as a graduate assistant at the same time. He was going without sleep, but feeling sleep deprived, so he was drinking caffeine energy drinks. He passed a big test, went out with the guys, and overdid the drinking. The next day, he played in a flag football game and got a head injury that required stitches. After the injury, he was sleeping maybe 2 hours a night, and felt terrible. Two days later he has a psychotic break!!!!!

I swear he never exhibited bipolar symptoms growing up. He did have test anxiety and some attention issues in school, but overall was a good student, etc. He did not have extreme mood swings.

As a result of the psychotic break, he was hospitalized, and came out of it, on Seroquel. He has managed ok, but has terrible self-esteem issues because of it. The doctor at the mental health center has now switched him to Abilify.

How can we be sure he needs these meds?? Does he have bipolar or was it just a combination of crap that produced the perfect storm????

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.

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.

During an acute and severe manic episode, a doctor is likely to treat mania more aggressively, perhaps by taking the following steps:

• Prescribing substantial doses of medications such as Abilify or Seroquel.
• Using loading doses of Depakote to reduce acute mania more rapidly. A loading dose is a higher initial dose than normally prescribed. Loading doses are used to ramp up a medication to a therapeutic level more rapidly.

These more aggressive interventions for mania are often performed in hospital. When providing outpatient treatment, doctors usually ramp up these medications more slowly to reduce side effects. Lamictal, which is used to prevent mood cycles, requires many weeks to reach a therapeutic level because of the risk of a skin condition that is much lower if the doses are increased very slowly.

Antidepressants are another story. Routinely, patients are told that they won’t be likely to experience any benefits from their antidepressants for at least a few weeks. Sometimes it can take much longer, and doctors rarely, if ever, suggest what to do in the meantime. Patients are often expected to tough it out. And if the person complains, the doctor often advises them to “BE PATIENT.” Easier said than done in the midst of debilitating depression.

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.

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.

Romy103 Asks…

My 21-year old daughter is diagnosed with Bipolar II. After being on Welbutrin and Lamictal, for awhile and doing well, she thought she was okay and decided to stop her medications. She relapsed, and the meds didn’t work as well when she went back on them. So Prozac and Lamictal were tried I believe, then Cymbalta – neither seemed to help. Now a new psychiatrist is prescribing the extended release form of lithium. So far not getting any results, but not up to therapeutic dose yet. While I understand the good things about lithium, I have a few concerns/questions about it:

Garett Asks…

Five months ago, I was diagnosed as having bipolar disorder. First I was on Depakote and then I told my doctor I was still having major problems with my sleep. I was always up and about knowing it was 3 o’clock in the morning. I told her about the lack of sleep, and she immediately took me off of the Depakote and switched me to Seroquel.

Last week, Joe posted a piece entitled “Bipolar Dilemma: Insensitive Jerk or Irresponsible Oaf?” in an attempt to spark a discussion and collect insights on what to do when you sense that your loved one with bipolar is exhibiting symptoms of mania or hypomania. This week, Dr. Fink weighs in.

Dr. Fink Replies…

This dilemma lies at the heart of so much of the strife that families living with bipolar disorder face every day. I don’t have any magic answers – I suspect that people living with these challenges have creative solutions that will be more helpful to others than anything the doctor might have to offer.