bipolar disorder, depakote, tegretol, lithium Dr. Paul Markovitz  Q. My new wife has just been diagnosed with bipolar disorder. I am in the military and stationed far away from her (at least for the next 7 months). I get little information from her due to her current depressed state, and I am leery of treading upon a doctor/patient relationship to get information. I know little about this disorder aside form what I have read on various websites. From what I have read, the sites' information conforms with my wife's behavior. I have a few questions for you:

1. Is this disorder a permanent condition or can it be "cured" or simply "go away?"

2. How prevalent is suicide with this condition??

3. What are the medications that have the least side effects?

4. Will insurance companies pay for the medications to treat this disorder? If so, will insurance companies brand my wife as being "insane" with adverse effects?

5. Can companies willfully not hire people with bipolar disorder based only on the condition that they have a mental disorder?

  A. These are very good questions, and clearly need addressing. First, it is important that you know about the disorder so you can help her when she is ill. Any good psychiatrist would pretty much insist that you be part of the treatment team. Keeping an illness "covered up" like bipolar disorder under the guise of patient/doctor relationship is a false claim. You have to know about the illness and what to do to help in both times of good and bad.

1. The disorder is permanent. Your wife will have bipolar disorder for the rest of her life. Now, there are different kinds of bipolars, so she may present with other manifestations of the illness as time goes on.

2. Suicide is fairly common with the disease. It may occur in as many as 10% of individuals, but probably is closer to 2-3%. Still an alarmingly high number. With good treatment and follow-up, it can be pretty well reduced to zero for most folks. Good follow-up is key.

3. Medications for bipolar disorder are many. Which ones are used will depend on individual patient characteristics including sex, type of bipolar disorder, whether your wife wants to become pregnant on medications, concomitant psychiatric and physical illnesses, and most importantly, individual reactions to medications. Some folks have a ton of side effects to medications that are usually benign, while others have no side effects to medications with horrible side effect profiles. Groupings of medicaments include lithium (the classic), anticonvulsant (Depakote, Tegretol, Neurontin, and others), neuroleptics (usually reserved for manic episodes), antidepressants (usually reserved for depressive episodes but also effective in bipolar IIs), and electroconvulsive therapy. Your psychiatrist should help with choices and insure that the best one is used for your wife.

4. Insurance companies usually pay for psychiatric medications. It becomes difficult to get life insurance and new health insurance because of a pre-existing condition. This would also be true if she had heart problems or diabetes, and is not unique to mental health.

5. It is illegal to deny anyone a job because of an illness, unless that illness can be shown to put others at risk. If the problem arises, get legal advise. Most companies just want good workers.