bipolar disorder, Dr. Paul Markovitz  Q. Thank you for this fantastic opportunity to have some questions answered. My daughter is 30 years old, has always been moody, apparently cut her wrists at university and also suffered with bulimia. In 1996 she was prescribed an antidepressant, Sertraline and 9 weeks later went hypomanic which lasted four months. Was on Haloperidol 25 mg a day then Droperidol gradually reducing to nil after 16 weeks. She was then thought to be depressed and started on Lithium and an antidepressant for just under a year. She wanted to discontinue then. In 1998 she again was prescribed an antidepressant and went hypomanic again after a few months, treated much earlier with Droperidol, this lasted high lasted 18 days. She went on Lithium again, then went into a very bad depression lasting about 5 months. Was also on Prozac from June 1999. Was slightly psychotic at some point and on Risperidone between 1.5 and 3 mg od in August 1999.

Had been drinking quite heavily and using Cannabis and had another episode in December 2001, was high for about 4 weeks and put on Droperidol 20 mg od. Now is having panic attacks, and anxiety. Is on no medication (her choice). She is under a psychiatrist.

1. Do you think this is bipolar I or bipolar II or something else.

2. Is the anxiety she is now having likely to lead to another major depression?

3. Do you think she would be suitable for the new drug trial you mention Aripiprazone?

3. She has terrible problems sleeping what do you think is the best for this. She takes Nytol but does not always work.

4. Would lack of sleep produce psychotic symptoms in anybody or just some one with mental health problems?

  A. . 1. Sounds like bipolar II disorder. Most Bipolar I patients do not have panic or eating disorders.

2. She is almost guaranteed a return of hypomania or depression if she is not on a medication to control the illness.

3. She will get into the aripiprazole trial if she is manic, but not if she is depressed. I would suggest using Geodon, which is already on the market. Very good medication for mania, and it has little sedation or weight gain. It is currently my drug of choice in bipolar I and II disorder with clear manias. It works as well as aripiprazole, and she will not need to worry about getting placebo.

4. Sleep disturbances are part of bipolar disease. If she is on the right medication, her sleep should markedly improve. Nytol is not the answer. It is just diphenhydramine (Benadryl).

5. Lack of sleep will eventually make anyone psychotic. However, normal people fall asleep the night after a night of poor sleep. Depressives and manics do not.