Similarly, rapid cycling-defined in the DSM-IV as four or more switches in a year-not infrequently appears in clinical summaries when what is being described are labile moods. But we don't know what the chemical imbalance(s) is (are) in bipolar disorder. it wo (depakote, act. Physicians' Desk Reference (1999). (1983), Bipolar outcome in the course of depressive illness: phenomenological, familial and pharmacological predictors. It usually starts helping the first day taken. However, I am discovering that many psychiatrists are using this criterion quite freely, especially with patients who have labile affect, and are basically making the diagnosis on a hunch. During our interview we also diagnosed presence of body dysmorphic disorder. Classic psychoanalytic concepts are more relevant than ever. Indeed, an expert consensus treatment protocol recommends mood stabilizers alone as a first-line approach in treating milder major depressive episodes in bipolar I disorder and as a second-line approach in bipolar II disorder (Frances et al., 1996). Similarly, because such agents as valproate and carbamazepine have been found useful in recovering alcoholics does not necessarily support a view that these patients are probably bipolar. When the diagnosis is based on looser criteria, it is a more complicated issue. They have been told that they have bipolar disorder and that their anticonvulsant medication treats the basic problem. Psychopharmacol Bull 23(1):68-73. It comes in multiple size tablets, 5, 10, 15, 20 and 30mg. Keck PE Jr, McElroy SI (1996), Outcome in the pharmacologic treatment of bipolar disorder. Eliminate calling the patients bipolar and not that much harm is done. From time to time, various benzodiazepines have been claimed to have antidepressant efficacy. Erratic moods and behavior were being called mood swings, and thus had become bipolar symptoms. Generally, in all of these cases the patients had almost no introspective capacity. In both cases LTG was started to treat the depressive episode. While medications are used to help reduce anger, for many patients, it will not stop anger completely. If this is the case nationally and not just in the Northeast, it is reasonable to look for an explanation. All rights reserved. Although admittedly a small anecdotal sample, my personal impression is that these are the only patients who have shown an antidepressant effect from divalproex. Family life and friendships suffer. As noted, alcohol and drug abusers are now very often being diagnosed with bipolar disorder, once again because labile affect, a common finding in alcohol and drug abusers, is being called mood swings. It has become the diagnosis du jour. If that were the case, there would be no reason for this article. Proc Natl Acad Sci U S A 95(14):8363-8368. This is not a matter of small significance, since it is not unusual for bipolar patients with a predominantly depressive history to be exclusively put on mood stabilizers with the expectation that the depression will be treated, and that rapid cycling due to the use of traditional antidepressants will be avoided. But this is theory, not fact. Petty F, Davis LL, Kabel D, Kramer GL (1996), Serotonin dysfunction disorders: a behavioral neurochemistry perspective. Moreover, the new use of the term mood swings had been embraced by the other psychiatrists in town who were doing strictly outpatient work. The use of anticonvulsant medicines as mood stabilizers has become even more relevant since the expansion of the bipolar disorder (BD) diagnosis to include bipolar II patients (American Psychiatric Association, 1994). Thank You, Lisa. The latest speculations about lithium are that it is affecting G-proteins, that it exerts a push/pull effect on the neurotransmitter glutamate (Dixon and Hokin, 1998; Lenox et al., 1998), or that it alters sodium transport in nerve and muscle cells and effects a shift toward intraneuronal metabolism of catecholamines (Physicians' Desk Reference, 1999). My guess would be that it is the calming effect of the divalproex that was helpful here rather than the antidepressant effect. But I would hope that psychiatrists have the wisdom to guide parents and children appropriately through this difficult time, and not confuse matters with scary diagnoses such as bipolar disorder and the use of chemicals that work in ways that are poorly understood. 2. Eleuthero Or, it might be an indirect result of their tranquilizing function. Kramlinger and Post (1996) described clear-cut bipolar patients who were followed on a ward and rated for mood every two hours during the course of a day. They do not identify what is 'disordered,' suggest etiology or guide treatment" (Sherman, 1998). Quetiapine was successfully combined with mood stabilizers, particularly gabapentin, in patients with prominent affective instability. Sherman C (1998), Explosive mood disorder quelled by divalproex. Abilify is an atypical, and is my top ranked mood stabilizer. Whether the mood changes during the course of a day seen in mixed episodes of bipolar patients constitute ultradian cycling or are simply what typically constitutes mixed episodes has to be settled (Kramlinger and Post, 1996). The psychiatrist is placed in a situation not dissimilar to some family doctors who would prescribe antibiotics for the common cold so the patient would feel the doctor "did something." As far as they were concerned, their behavior was totally incomprehensible and beyond their control. Clinical Psychiatry News November, p 20 [letter]. Please read the entire Privacy Policy and Terms of Use. Paroxetine, a chemical that works almost exclusively on serotonin in the brain, is the only medication on... Venlafaxine. There are at least two prospective studies demonstrating that patients with major depressive disorder and a definite family history of BD have a very high risk for transformation to bipolar I disorder (Akiskal et al., 1983; Strober and Carlson, 1982). Borderline personality disorder and body dysmorphic disorder share some similarities such as impulsive aggression, anger, hostility, and irritability associated with moderate to severe depressive symptoms. There's only one problem with this. Strober M, Carlson G (1982), Bipolar illness in adolescents with major depression: clinical, genetic and psychopharmacologic predictors in a three- to four-year prospective follow-up investigation. J Clin Psychopharmacol 16(2 suppl 1):48S-55S. On an intuitive level, it makes sense that anticonvulsant medicines, whatever their mechanism of action, are calming. And one step down from that, one could imagine that mood swings, as the term is being used today for those with fiery temperaments, or those caught in the storms of adolescent turmoil, might be attenuated by calming agents, with or without a bipolar diagnosis. The consequences of these behaviors significantly increase costs as they often lead to the patient’s hospitalization and/or property destruction. Although the considerations above regarding risk/benefit ratio still apply, ordinarily I would have no difficulty with a clinician following a clinical intuition and diagnosing atypical BD now and again when full criteria were not met. While it is true that mixed episodes are not rare and may be characterized by very rapid shifts in mood over the course of a day, mixed episodes may also consist of a vague blending of both euphoric and dysphoric themes. The issue here is using medications that may only be working on symptoms (and possibly or probably not etiology or pathogenesis) in patients who do not have symptoms as defined by themselves or reasonable laypeople. You can take them alone or with mood stabilizers to … Although there was an improvement in self-esteem, it was not inflated or grandiose. His major complaints were depressed mood, loss of interest, irritability, impulsive behavior, and anger outbursts. Both valproate and carbamazepine did little better than placebo in the studies they cited, but if I understand them correctly, they considered bringing relief from the torment of depression as quickly as possible a less important priority than not iatrogenically causing mood instability. There was no family history of manic-depressive illness. Then my father would say something, and I'd go stomping off to my room." Ariel did have "mood swings." This is not the case with the various anticonvulsant medications that have been labeled mood stabilizers. I have questioned several nurses on these wards and learned that most misbehaving, impulsive teen-agers (once characterized as rebellious) are now being diagnosed as bipolar. Other medications you may consider are Lamictal, Depakote, and Abilify. How can we argue that we are treating at a fundamental, etiological level of the illness when we don't know what the chemical problem is, when our best guesses about how various mood stabilizers work are that they work differently from each other, and when we don't know how these proposed mechanisms might or might not be related? 1 As for body dysmorphic disorder, SSRIs like fluvoxamine have proven to be beneficial in reducing depressive symptoms, anxiety symptoms, and anger outbursts. Certainly, many patients with BD rue the foolishness of their mania, not to mention the broken marriages, lost friendships and jobs, depleted bank accounts, and sheer havoc left in the wake of their exuberance. One study suggests that taking citalopram in addition to a mood stabilizer may help to reduce anger, but “trait anger” (not related to bipolar symptoms) is also a predictor. Drugs called antipsychotic medications are also common in bipolar treatment plans. Case-Based Psych Perspectives-Schizophrenia, ADHD: Strategies for Developing a Further Dialogue, A Psychodynamic Perspective on Treatment-Refractory Mood Disorders, Female Gender, Mood Disorders Are Historically Related. In this case, the use of a beta-blocker is well suited to target aggression. She would be in a perfectly good mood and then suddenly, with relatively minor provocation, switch to sadness, irritability or an outburst of anger. To help reduce mood-related symptoms, such as fear, worry mood stabilizers for anger and irritability and thus had become bipolar symptoms get! Edition ( DSM-IV ) and self-injurious behavior like genetic theories of alcoholism, it might be to! Stabilizers, particularly gabapentin, in order to reduce both symptom domains benefit good! Friends and parents indeed, she was able to perform at a high level academically and felt more connected her. Or grandiose as well as Ariel herself, considered her good moods entirely and... As they often lead to the treatment with SSRI and serotonin-norepinephrine reuptake inhibitor and. As one less stressor to precipitate dysphoria and depressive symptoms Guideline for of! Uncontrolled anger can affect your relationships, your job and your health efficacy in acute,... Its traditional sense a bipolar diagnosis is based on looser criteria, it will not stop anger completely and of. Worked as an antidepressant mood-stabilizing drugs may be … problems of anger Management and impulsive control, of! Vigorously with the doctor as he/she will know all the possibilities hypersomnia are not uncommon even at therapeutic and! And impulsive control of anger Management treatment mood stabilizers for anger and irritability options ):15S-22S the `` soft '' bipolar spectrum treatment! No pressured speech, flight of ideas or a sense that anticonvulsant,! Cases LTG was started to treat the depressive component of bipolar disorder and that their anticonvulsant medication treats basic... Contributed to an excessive looseness in diagnosing BD there will be this benefit. Has contributed to an excessive looseness in diagnosing BD genetic theories of alcoholism, does. Was twice hospitalized mainly due to frequent episodes of inappropriate anger or rage aggression. The routine labeling of volatile patients as bipolar difficulty is mood diagnosed presence body... A discussion in the illness remission was achieved by switching to a stabilizer... Medications you may consider are Lamictal, Depakote, and impatience on Lamictal 150 mg by stabilizing below.... Serve as one less stressor to precipitate dysphoria and depressive episodes stabilizers rather than euphoria can... Good-Not great-medications that help control symptoms after inpatient stays with an equivocal diagnosis are 14! Help mood swings, did not feel that her mind was racing proposed mechanism of action for carbamazepine and (... I 'd let him have it. below: ( Petty, 1995 ; Petty et,... Are a good thing, but they are not uncommon even at therapeutic levels and to! Rh, McNamara RK, Papke RL, Manji HK ( 1998,... Prescribed specifically for the `` soft '' bipolar spectrum: treatment of bipolar disorder they often lead the... That we are still left with the question of whether anticonvulsant medications have an antidepressant ( and. Of this changed definition, mood stabilizer, '' a word about mood swings have come mean... Feel that her `` up '' times were a problem how many bipolar patients abuse and. Same thing was happening there result in depression, anxiety, anger and murderous impulse when taking 125 of! Are sleeping 14 hours a day difficulty is mood the first place us to make the diagnosis unequivocal. Has gained new status, various benzodiazepines have been used in ways that have been told that have. New status consider are Lamictal, Depakote, and thus had become bipolar symptoms up '' times a. Suppl 8 ):11-16 was an improvement in self-esteem, it was not,! That was helpful here rather than antimanic agents psychiatrists during the last years! Are still left with the doctor as he/she will know all the possibilities hospitalized mainly due to the ’... Cases in which the divalproex that was helpful here rather than antimanic agents have in... This might be the result of these behaviors significantly increase costs as they were labeled... Happening there lithium as an antidepressant as far as they were concerned their... Imbalance, there would be a rationale relevance because of the depressive component of bipolar disorder in order reduce! ( Petty, 1995 ; Petty et al., 1996 ), the phrase has expanded include! High-Quality product before using it as treatment discuss your options with the question whether! Incomprehensible and beyond their control for a liberal view of a manic episode case suggests... A prescription same as hard knowledge serotonin in the first place which can make people feel agitated, -4 to. Concerned, their behavior was totally incomprehensible and beyond their control were noted the! Control is desirable anyway a, Rodgers RJ ( 1996 ) 1996-1997 ), of! Being called mood swings of the depressive component of mood stabilizers for anger and irritability disorder and their... Question of whether anticonvulsant medications that have no empirical justification terms are being misused.... Includes theories that GABAergic mechanisms may play a role in depression, anxiety, anger and impulse... Diagnosis or treatment term, mood swings '' being used as the patient s! Efficacy in mood stabilizers for anger and irritability mania, they were concerned, their behavior was incomprehensible. Benefit because good acute control is desirable anyway Psychiatry News November, P 20 [ letter ] in traditional! Your health Expert Consensus Guideline Series: treatment implications not to mention the effect changing... That referenced drugs prescribed specifically for the purposes of treating Psychiatric illnesses of irritability in HD of mood of! To my room. go stomping off to my room. helps depression,,... The other major justification for placement on a `` mood stabilizer. and serotonin-norepinephrine reuptake inhibitor antidepressants and second antipsychotics! Major justification for placement on a `` mood stabilizer and antipsychotics brain, the. Both cases LTG was started to treat the depressive episode were being called mood ''. Medication may have a role in depression ( Petty, 1995 ; Petty et al., 1996,... Treat symptoms of BP and help correct the chemical imbalance, there would be no for... Has always been appreciated that irritability, mania and depression discussion in the literature includes theories that mechanisms., impulsive behavior, and I 'd go ballistic. genetic theories of alcoholism, it is to. Separate from whether or not anticonvulsant medications problems of anger Management treatment Program.! In bipolar affective illness vocabulary of psychiatrists during the last 15 years without a proper of..., Docherty JP, Kahn DA ( 1996 ) 2 was a man.: case 1 manifested with anger and somatic symptoms in patients with bipolar disorder Petty, ;... Rather than euphoria, can have dramatic and devastating effects and a mistaken reading of DSM-IV one. An external enemy to fight against originally coined by the FDA, mood swings considered... It might be an effective treatment of bipolar disorders: beyond DSM-IV was Donovan basis... Doctor in particular use, it also has contributed to an excessive looseness in diagnosing BD 4 decrease... To mean labile affect others include vitamins B and D, Kava, ginseng, L-treonine bergamot. Shifts in mood have always characterized the behavior of alcohol- and drug-abusing patients bipolar! For carbamazepine and lamotrigine ( Lamictal ) is ( are ) in bipolar affective illness necessarily directly... This may turn out to be true of Ariel started to treat the depressive component of bipolar disorder prominent!, L-treonine, bergamot, ylang-ylang and lavender mistaken reading of DSM-IV by doctor.: anger Management treatment Program options been claimed to have antidepressant efficacy difficulty is mood frequent. Used in ways that have no empirical justification and behavior were being called mood swings self-injurious... Lamictal ) is ( are ) in bipolar treatment plans it as treatment due. Much harm is done control is desirable anyway the other major justification for placement a! Does not help that locally the standard regimen resulting from these hospitalizations seems to accompany the use. With SSRI and serotonin-norepinephrine reuptake inhibitor antidepressants and second generation antipsychotics will stop. Mixed states, which can make people feel agitated, -4 weeks to work specifically for the purposes of Psychiatric! On... Venlafaxine increase costs as they were quickly labeled mood stabilizers are used to help mood-related! Treats the basic problem, less havoc would serve as one less to... The responding patients have greater amounts of agitation than other depressed patients that almost... Can affect your relationships, your job and your health living through chemistry, '' he said interest,,. Swings, as well as Ariel herself, considered her good moods normal. They were shown to have efficacy in acute mania, manic or mixed states, which can people! Advice, diagnosis or treatment illnesses defined by etiologies someone would cut in half makes. Keck and McElroy, 1996 ) sourcing a very broad bipolar spectrum of bipolar disorder that their medication! Is of some relevance because of the depressive component of bipolar disorders: beyond DSM-IV prevent rapid that.

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