# Questions about drugs prescribed for bipolar disorder **URL:** \ **Category:** Factual Questions\ **Created:** [February 10, 2009, 9:45pm UTC](https://boards.straightdope.com/t/questions-about-drugs-prescribed-for-bipolar-disorder/485283 "2009-02-10T21:45:26Z")\ **Posts on this page:** 15\ **Page:** 1
**Author:** ![Skald\_the\_Rhymer](https://avatars.discourse-cdn.com/v4/letter/s/ecccb3/32.png) [@Skald\_the\_Rhymer](https://boards.straightdope.com/u/Skald_the_Rhymer)\ **Post date:** [February 10, 2009, 9:45pm UTC](https://boards.straightdope.com/t/questions-about-drugs-prescribed-for-bipolar-disorder/485283/1 "2009-02-10T21:45:26Z")
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. ---
**Author:** ![Angel\_of\_the\_Lord](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/angel_of_the_lord/32/2949_2.png) [@Angel\_of\_the\_Lord](https://boards.straightdope.com/u/Angel_of_the_Lord)\ **Post date:** [February 10, 2009, 9:56pm UTC](https://boards.straightdope.com/t/questions-about-drugs-prescribed-for-bipolar-disorder/485283/2 "2009-02-10T21:56:58Z")
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? ---
**Author:** ![Skald\_the\_Rhymer](https://avatars.discourse-cdn.com/v4/letter/s/ecccb3/32.png) [@Skald\_the\_Rhymer](https://boards.straightdope.com/u/Skald_the_Rhymer)\ **Post date:** [February 10, 2009, 10:22pm UTC](https://boards.straightdope.com/t/questions-about-drugs-prescribed-for-bipolar-disorder/485283/3 "2009-02-10T22:22:21Z")
> [@Angel\_of\_the\_Lord](#): > > 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? ---
**Author:** ![Angel\_of\_the\_Lord](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/angel_of_the_lord/32/2949_2.png) [@Angel\_of\_the\_Lord](https://boards.straightdope.com/u/Angel_of_the_Lord)\ **Post date:** [February 10, 2009, 11:00pm UTC](https://boards.straightdope.com/t/questions-about-drugs-prescribed-for-bipolar-disorder/485283/4 "2009-02-10T23:00:48Z")
Just out of curiosity. ---
**Author:** ![MsRobyn](https://avatars.discourse-cdn.com/v4/letter/m/90ced4/32.png) [@MsRobyn](https://boards.straightdope.com/u/MsRobyn)\ **Post date:** [February 11, 2009, 1:36am UTC](https://boards.straightdope.com/t/questions-about-drugs-prescribed-for-bipolar-disorder/485283/5 "2009-02-11T01:36:42Z")
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 ---
**Author:** ![Squink](https://avatars.discourse-cdn.com/v4/letter/s/b5e925/32.png) [@Squink](https://boards.straightdope.com/u/Squink)\ **Post date:** [February 11, 2009, 2:26am UTC](https://boards.straightdope.com/t/questions-about-drugs-prescribed-for-bipolar-disorder/485283/6 "2009-02-11T02:26:28Z")
[Tricyclics](http://en.wikipedia.org/wiki/Tricyclic_antidepressant) were popular for bipolar back in 87. Many of them eventually induced mania or rapid cycling. When that happened, [lithium](http://en.wikipedia.org/wiki/Lithium) was given a try, or large doses of [benzodiazepines](http://en.wikipedia.org/wiki/Benzodiazepine) 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:](http://money.cnn.com/magazines/fortune/fortune_archive/2005/11/28/8361973/index.htm) > [@](#): > > Within three years of Prozac’s launch, annual sales neared $800 million. Newsweek put the pill on its cover–a green-and-white capsule floating against a blue sky under a headline that hailed it as a breakthrough drug. Even healthy people were asking for Prozac, the magazine noted. By 1993 the idea caught on that SSRIs could transform lives- ---
**Author:** ![Oregon\_sunshine](https://avatars.discourse-cdn.com/v4/letter/o/50afbb/32.png) [@Oregon\_sunshine](https://boards.straightdope.com/u/Oregon_sunshine)\ **Post date:** [February 11, 2009, 2:30am UTC](https://boards.straightdope.com/t/questions-about-drugs-prescribed-for-bipolar-disorder/485283/7 "2009-02-11T02:30:06Z")
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! ---
**Author:** ![susan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/susan/32/17537_2.png) [@susan](https://boards.straightdope.com/u/susan)\ **Post date:** [February 11, 2009, 8:32am UTC](https://boards.straightdope.com/t/questions-about-drugs-prescribed-for-bipolar-disorder/485283/8 "2009-02-11T08:32:52Z")
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. ---
**Author:** ![GorillaMan](https://avatars.discourse-cdn.com/v4/letter/g/50afbb/32.png) [@GorillaMan](https://boards.straightdope.com/u/GorillaMan)\ **Post date:** [February 11, 2009, 12:58pm UTC](https://boards.straightdope.com/t/questions-about-drugs-prescribed-for-bipolar-disorder/485283/9 "2009-02-11T12:58:59Z")
> [@MsRobyn](#): > > 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. My current psychiatrist explained the difference succinctly with a couple of graphs, replicated [here](http://www.owainsutton.co.uk/images/graphs.jpg) 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!) ---
**Author:** ![Skald\_the\_Rhymer](https://avatars.discourse-cdn.com/v4/letter/s/ecccb3/32.png) [@Skald\_the\_Rhymer](https://boards.straightdope.com/u/Skald_the_Rhymer)\ **Post date:** [February 11, 2009, 3:11pm UTC](https://boards.straightdope.com/t/questions-about-drugs-prescribed-for-bipolar-disorder/485283/10 "2009-02-11T15:11:52Z")
> [@susan](#): > > 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. 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. ---
**Author:** ![KneadToKnow](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/kneadtoknow/32/3999_2.png) [@KneadToKnow](https://boards.straightdope.com/u/KneadToKnow)\ **Post date:** [February 11, 2009, 3:18pm UTC](https://boards.straightdope.com/t/questions-about-drugs-prescribed-for-bipolar-disorder/485283/11 "2009-02-11T15:18:03Z")
Serious question: do they really use the term “high-functioning” with BPD? I thought that was just for things like autism. ---
**Author:** ![Skald\_the\_Rhymer](https://avatars.discourse-cdn.com/v4/letter/s/ecccb3/32.png) [@Skald\_the\_Rhymer](https://boards.straightdope.com/u/Skald_the_Rhymer)\ **Post date:** [February 11, 2009, 3:23pm UTC](https://boards.straightdope.com/t/questions-about-drugs-prescribed-for-bipolar-disorder/485283/12 "2009-02-11T15:23:00Z")
> [@KneadToKnow](#): > > 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. ---
**Author:** ![Squink](https://avatars.discourse-cdn.com/v4/letter/s/b5e925/32.png) [@Squink](https://boards.straightdope.com/u/Squink)\ **Post date:** [February 11, 2009, 3:29pm UTC](https://boards.straightdope.com/t/questions-about-drugs-prescribed-for-bipolar-disorder/485283/13 "2009-02-11T15:29:37Z")
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](http://www.google.com/search?q=%22high-functioning+bipolar%22&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. ---
**Author:** ![Mr.Slant](https://avatars.discourse-cdn.com/v4/letter/m/c57346/32.png) [@Mr.Slant](https://boards.straightdope.com/u/Mr.Slant)\ **Post date:** [February 11, 2009, 4:10pm UTC](https://boards.straightdope.com/t/questions-about-drugs-prescribed-for-bipolar-disorder/485283/14 "2009-02-11T16:10:49Z")
> [@Skald\_the\_Rhymer](#): > > 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. 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! ---
**Author:** ![Mirror\_Image\_egamI\_rorriM](https://avatars.discourse-cdn.com/v4/letter/m/e56c9b/32.png) [@Mirror\_Image\_egamI\_rorriM](https://boards.straightdope.com/u/Mirror_Image_egamI_rorriM)\ **Post date:** [February 11, 2009, 7:46pm UTC](https://boards.straightdope.com/t/questions-about-drugs-prescribed-for-bipolar-disorder/485283/15 "2009-02-11T19:46:48Z")
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). > **[Carbamazepine](https://en.wikipedia.org/wiki/Tegretol)** > > Carbamazepine, sold under the brand name Tegretol among others, is an anticonvulsant medication used in the treatment of epilepsy and neuropathic pain. It is used as an adjunctive treatment in schizophrenia along with other medications and as a second-line agent in bipolar disorder. Carbamazepine appears to work as well as phenytoin and valproate for focal and generalized seizures. It is not effective for absence or myoclonic seizures. > Carbamazepine was discovered in 1953 by Swiss chemist Walt...