Dr Vikas : Hello, I am Dr Vikas (M.D Psychiatry)and I’ll try to help you today.
Dr Vikas : the major differentiating feature between Bipolar 2 disorder and anxiety- depression is that a patient suffering from Bipolar 2 disorder has hypomanic episodes in addition to depressive episodes characterized by
Dr Vikas : "a distinct period of persistently elevated, expansive, or irritable mood, lasting throughout at least 4 days and present for most of the day nearly every day. This hypomanic mood is clearly different from the person's usual mood.During the period of mood disturbance, 3 or more of the following symptoms have persisted (4 if the mood is only irritable) and have been present to a significant degree: Inflated self-esteem or grandiosity Decreased need for sleep (e.g., feels rested after only 3 hours of sleep) More talkative than usual or pressure to keep talking Flight of ideas or subjective experience that thoughts are racing Distractibility (e.g., attention too easily drawn to unimportant or irrelevant external stimuli) Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation Excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., the person engages in unrestrained buying sprees, sexual indiscretions, or foolish business investments") "
Dr Vikas : Source "http://psychcentral.com/disorders/sx21.htm "
Dr Vikas : Anxiety symptoms can be present with Depressive disorder alone or with Bipolar disorder 2 also.
Dr Vikas : Alcohol abuse / dependence can further cause severe depression and Bipolar 2 disorder patients abuse alcohol frequently.
Dr Vikas : anxiety symptoms do not overlap with Bipolar 2 disorder symptoms.
Dr Vikas : Is it possible for you to ask him to try a short online screening quiz and let me know about his score.
Dr Vikas : this screening quiz can help a little bit in deciding whether or not he has Bipolar disorder.
Dr Vikas : http://psychcentral.com/quizzes/bipolarquiz.htm
Dr Vikas : I have given the link to that quiz above.
Dr Vikas : now I will wait for your reply.
Customer: Thank you for the information. Unfortunately he is going through one of his alcohol binging episodes. Reading the above I feel he may possibly be biploar 2. He often becomes very irritable and tends to fixate on a certain activity/hobby (for him it is Golf) or something bad that has happened. He seems to have manic episodes ranging every few weeks to as long as a few months apart. We are facing possible bankruptcy and I wonder of severe stress can bring on Bipolar 2 symptoms or if it just anxiety.
Customer: I should also mention that the drinking is so intense I do not believe he has eaten in 3 days. He actually left the house today to buy more alcohol with a child's football helmut on this afternoon. I am greatly concerned and do not know what to do for him at this point.
Dr Vikas : Thanks for your reply. It is a possibility that he is suffering from Bipolar 2 or severe depression with anxiety. excessive Alcohol consumption will only make him more depressed.
Dr Vikas : Is it not possible for you to ask his doctor to screen him for the possibility of Bipolar disorder. In a patient suffering from Bipolar disorder type 2, antidepressant when given alone can worsen or destabilize his mood further.
Dr Vikas : I am assuming that he must be only on antidepressant considering his diagnosis so after evaluating him for Bipolar type 2, his doctor can start mood stabilizer which should definitely help.
Customer: He has seen a general practitioner for his problems and was initially put on pristiq (50 mg) and alprazolam (.5 mg). With his alcohol use, he was completely out of control. That is when I started to suspect a larger problem. He is currently only taking alprazolam and no antidepressant. He claims he does not like the way it makes him feel. He says he feels like his mind is "cloudy"
Customer: What is the protocol for a spouse calling the family practitioner? Will he speak with me regarding my husband?
Dr Vikas : Honestly speaking, it is better to discuss this issue with his doctor whether or not he would like to include you in the treatment decision. Also, his GP can consider the option of referring him to a psychiatrist because he requires a specialist intervention in my view.
Dr Vikas : you can also discuss with your husband about changing the medicines and consulting a psychiatrist by telling him that if his current medicines are clouding his consciousness, change of medicines can be done by a specialist psychiatrist.
Customer: Ok, thank you. Out of curiosity, Are there psychiatric clinics or treatment centers available for situations such as this?
Dr Vikas : There are, but a referral from his GP is more appropriate because his GP knows in detail about his illness and can explain it better to another doctor which in this case is a psychiatrist.
Dr Vikas : All psychiatrist are well trained in treating Bipolar disorder.
Customer: This is all based upon the idea that he is a willing participant in his own treatment, correct? To date, he has not wanted to seek further help.
Dr Vikas : This link below can help in you in finding an appropriate psychiatrist.
Dr Vikas : http://www.consumersresearchcncl.org/Healthcare/Psychiatrists/psych_articles.html
Dr Vikas : see, a psychiatrist can motivate him to seek treatment.
Dr Vikas : easily
Customer: I wasn't sure if there were any other alternatives outside of leaving him and taking my children with me should he refuse treatment.
Customer: Thank you, XXXXX XXXXX check out the link.
Dr Vikas : you are most welcome.
Dr Vikas : Don't worry, with appropriate treatment, he will recover very soon.
Dr Vikas : Most patients do.
Dr Vikas : and having such a loving wife will certainly help him in recovering very fast.
Customer: Thank you for the kind words. Without appropriate treatment, is this an illness that gets more severe with age?
Dr Vikas : see it varies from patients to patients. Some patient may have a single episode only, some may have few episodes and some may suffer life long
Customer: Yes that makes sense. In retrospect, there have been "warning" signs over the past 10 years I have known him. But not nearly as severe as it has been in the past 2.5-3 yrs.
Dr Vikas : don't worry, with appropriate treatment his chances of recovery are very high
Dr Vikas : I am extremely sorry to say but I have to go now because of some important work. Do you have any other question.
Dr Vikas : If yes, we can continue after some time.
Customer: No thank you very much for your help
Dr Vikas : You are most welcome.
Dr Vikas : My goal is to provide you with excellent service and I hope I’ve provided the information you were seeking, if not, please let me know so that l can continue to help you. If you need more help, please use the reply tab to continue our conversation.If you do not require further assistance,please rate one of the positive ratings (3,4,5 / smiley faces) as this is the only way how we are compensated for our time and expertise.Please take a moment to rate the answer.Kind regardsVikas