bipolar disorder, Dr. Paul Markovitz  Q. . I started dating Gloria about 4 months ago & she told me she was bi-polar & has been from 20 - now 36 years old. It seems somewhat mild as far as the symptoms, so far. She has a lot of energy, talks fast a lot, but also can be very calm & romantic. She says she hasn't been on Zoloft & Lithium for a few months(But has been since 20 yrs. Old) , She chose not to take the meds, not her drs. Takes naps often. Been smoking since 25 yrs old (quitting now, hard withdrawals). She is a social drinker, about 3-4 drinks a week, 3 cups of coffee a day. Aerobics instructor since 20. 15 lbs over weight, although she use to be heavier. Was in a Psy. Hospital when she was 20 for a few months (VERY dark time for her!). Very verbally & physically abusive father (he sexually abused a few of her sisters supposedly). Been in therapy since 20. 4 brothers, 2 sisters. 1 other sister has BP worst. Gloria is very creative, smart, deep, responsible, VERY sexual, seems monogamous, verbally expressive. Has a drive to achieve a lot(talks about a lot but doesn't seem to follow through with the potentially harmful ideas like she turned down a job that might be too stressful for her, she said "it would throw her personal life out of balance because of the many extra hours it would be"). I guess my questions are:

I'm SCARED because of what I have been reading about this disorder. Should I be?
What the percentage, if we have children, that they will have BP? Can it get better with time? She says it has!
She gets very emotional sometimes around her period. Is there a connection?
Are there different levels of BP? In it's mildest form, is it still an intense disorder?
Is it possible for her to take the birth control pill while being on Zoloft & Lithium?
Does 16 years of being on these meds increase the chance of a birth defect?
Or minimize the possibility of having a child?
After reading all of this, what do you think I know??

  A. All good questions. First, there are different forms of bipolar illness and different intensities of the disease in each of the group. Thus, it would be inappropriate for me to try and guess what form she has, or its prognosis. There is just not enough data.

I am not aware of a past history of psychotropic medications causing birth defects down the road. Some medications we use are best avoided during pregnancy, but if they are stopped prior to getting pregnant, all is pretty good. From trials in print, the chances of having a bipolar child are higher than if neither of you were bipolar, but not so much so that you should avoid having kids if you want them. The chances of having a mood disorder are higher, but actually there is a higher chance of having a depression presentation than bipolar according to the literature with one bipolar parent.

Before jumping into anything, and basing your decision on incomplete information (including mine), the two of you should go to see a bipolar expert, and there are a number at the various universities throughout New York. Sit down, go over her history, and see what the people who treat this for a living have to say. They can answer your questions about type of illness, need for medications, consequences of using medications, risks of passing on the disease, etc., much better since they will have a fuller picture than me. It is the best thing to do. You have a right to know where you stand, too.