bipolar disorder, Dr. Paul Markovitz  Q. I have a question I would like to ask you about Bipolar Disorder. I am starting to think that I have this disorder but am still wondering. I know for sure that I have met the criteria for Major Depressive Episodes and I have had several of these episodes. What I wonder about is the mania. I do know that I would not meet the criteria for Bipolar 1 but I find the stuff I read about Bipolar 2 to be very familiar. Some of the things which I think may be hypomania are as follows.....

I just went through a period of time where I was working about 80 hours a week. When this started I felt like I could do anything. I could work continuously and this was great. I kept this up for a few weeks, going from one job to the next and barely seeing my own house a couple times a week. Then as the good energetic feeling started to wear off I started to get really edgy and irritable. Then I went really downhill and got very depressed following this. The depression lasted until medication started to work. I went back on lithium (along with Serzone) Once the doses of lithium and Serzone were right I was feeling fine again. Lithium is the only medication which ever seems to work for me.

I have a tendency to quit taking meds after being on them for a while because I feel "cured" and decide I don't need them anymore.

Other things I've done are build my website in a couple days from scratch (and I had never done any web design before) I just sat in front of my computer constantly until it was finished. I get big ideas and decide I have to do them right now. Sometimes I just get something in my head and decide I have to have it. I will get right into stuff and work and work at it endlessly until I have the product I want.....and usually when this type of thing is happening I'll get several more ideas all at once. If I get a lot of ideas going at once I find I keep getting distracted and everything is half finished until I end up in a depression and no longer care about any of it. It's strange that one minute something can feel very important to me and then all of a sudden I just don't care about it anymore.

Sometimes I cycle very a day or a few days. I don't know what to make of this but it sounds very similar to the stuff I've read about Bipolar 2. What does it sound like to you?

I am presently taking Serzone, 150 mg in the morning and 300 mg before bed. I am also taking Lithium, 600 mg before bed. I'm not sure of my exact lithium level but on 600 mg I have always been between .67 - .7 which is in the therapeutic range and when I am in this range I always seem to function quite well.

  A. From your vignette, it sounds like mania, but you really need a good clinical evaluation to make sure. Further, it is somewhat of a moot point since you pretty much use the same medications for both. Whether you have BPI or BPII, it is permanent, not curable as of yet, and needs to be continuously medicated. Take your medications. If you dislike them, get a second opinion.

Serzone may work better if you get it up to 500 mg to 600 mg per day. My patients take all of it at bedtime to reduce daytime sedation. It is a great choice for depression in your case, and highly unlikely to cause a manic episode.