Before anyone wonders, I am not looking for medical advice, and this thread has nothing to do with my wife. Instead I am once again working on a story. Specifically I’m looking for medicines a person suffering from bipolar disorder might have been prescribed in about 1987. Particularly helpful would be medicines a person might have been MIS-prescribed–that is, medicines that would not have been effective.
The character in question is a high-functioning manic-depressive.
Thanks in advance.
Would they have potentially been misdiagnosed? Some forms of bipolar disorder get much worse with the addition of antidepressants without a mood stabilizer. So. . .guy comes in, gets diagnosed with depression. They give him, say, one of the old tricyclic antidepressants that were out there. . .and suddenly, he’s much less functional.
This can be helped by prescribing something like lithium, but. . .a lot of people go through hell when they’re misdiagnosed with MDD when they’re actually bipolar.
And. . .JOOC. . .are you talking straight-up bipolar disorder, or cyclothymia?
I couldn’t say. It doesn’t matter for the story, as the diagnosis is not stated; the viewpoint character simply knows that there is something mentally not right with another character.
And what’s JOOC?
Just out of curiosity.
It really does depend on which kind of bipolar disorder you’re talking about, since treatment varies.
Bipolar I involves manic episodes, by which I mean “mowing the lawn at 2 a.m.” mania.
Bipolar II involves mostly depression, where the mania brings the person to more-or-less normal levels. This can be a bitch to diagnose, since you notice the depression and don’t always attribute the normal moods to mania. I myself wasn’t accurately diagnosed until a few years ago, and even then the tipoff was that Prozac sent me to the races, something I didn’t think was abnormal until the nice psychiatrist asked me about it.
Cyclothymia involves mood swings that aren’t as severe as bipolar, but which still impair functioning.
IANAPsychologist/psychiatrist, and I’m sure one will come along and elaborate on and/or dispute my Cliff’s Notes version.
For the purposes of your story, perhaps the character in question can have Bipolar II that was mis-diagnosed as major depression, given Prozac, then everyone wonders why he’s mowing the lawn at 2 a.m., or whatever the story has him doing.
Robin
Tricyclics were popular for bipolar back in 87. Many of them eventually induced mania or rapid cycling.
When that happened, lithium was given a try, or large doses of benzodiazepines such as Klonopin, Ativan, or Lorazepam.
Antipsychotics such as haldol and stelazine also saw frequent action.
While Prozac was approved by the FDA in 87, it took a few years to penetrate the market:
In 1987, the drug for bipolar was Lithium. I don’t recall there were a lot of alternatives back then. Anyway, a mis-prescribed 1987 drug for bipolar may have been an antidepressant, perhaps Prozac (which was just invented/approved at that time - or just about to be approved - unsure which). If not Prozac, perhaps a tricyclic like Elavil - definitely an old school antidepressant.
ETA: Squink said it faster, and better!
Lithium. But bipolar disorder might well have been misdiagnosed as, say hebephrenic schizophrenia. You probably want to look at a DSM III (I think) for diagnostic labels and descriptions. At that time, the term “bipolar” wasn’t much used (“manic-depressive” was more common), and a lot of people we’d diagnose with it today were diagnosed with schizophrenia or depression.
My current psychiatrist explained the difference succinctly with a couple of graphs, replicated here with MS Paint. That the top of the curves on the lower graph, the rollercoaster I’ve been on for a long time, seemed like ‘normal’ to anybody who was seeing me at that time had previously led to me getting the following diagnoses from various other medical professionals, both psychiatrists and others:
Depression
Depressive tendencies
Anxiety
Depression with anxiety
It’s all in the mind (yes, I got told pretty much that)
Depressive episodes (close, but not close enough)
It’s all caused by deep-rooted early childhood experiences (I didn’t stick with that guy for much longer!)
Well, I’m never going to use the name of the illness anyway, as the characters don’t like acknowledging the…issues…the bipolar person has. But one character is asked by another what drugs the other person is using.
Serious question: do they really use the term “high-functioning” with BPD? I thought that was just for things like autism.
Now that I think about it, I’ve only heard it used for conditions like autism and schizophrenia.
It does get used occasionally, see:
http://www.google.com/search?q="high-functioning+bipolar"&ie=utf-8&oe=utf-8&aq=t&rls=org.mozilla:en-US:official&client=firefox-a
But I think it appeared on the scene after Sally Struthers or Golda Meier, or Morris Udall* or someone came out with a book on how they coped, and were a ‘high functioning’ bipolar. Not sure when that would have been.
*I have no clue who it would have been, that was a long time ago.
In '94 I was misdiagnosed with schizophrenia and placed on an antipsychotic, when the real problem is closer to bipolar or cyclothimia [sp?]. Out of a half-dozen mental health professionals I’ve seen since then, not a single one has come up with schizophrenia as an answer.
Thanks, Duke Medical Center!
Carbamazepine (aka Tegretol) is an anticonvulsant/mood stabilizer that was approved in the US in 1974. I remember that my doctor told me it was an “old” medication when he prescribed it. It’s working quite well (I’m bipolar II).
