Long-term drug effects unknown

DEAR DR. GOTT: My 23-year-old son was diagnosed with bipolar illness about a year ago. He is taking Depakote and Abilify and seems to be doing rather well. Are there long-term side effects from these medications, and what causes this mental illness, anyway?

DEAR READER: Side effects of Abilify include a possibility of tardive dyskinesia (TD), involuntary, repetitive movements of the limbs, trunk and facial muscles. Abilify has been around for fewer than 10 years, so long-term effects are essentially unknown. But the product has so far been shown to have a much lower risk of TD when compared with older antipsychotic drugs.

Your son may also experience weight gain, which can likely be controlled through diet and exercise.

Bipolar disorder generally requires lifelong treatment, even during times when a patient is seemingly symptom-free. A person will likely be under the guidance of a psychiatrist and perhaps a therapist or psychiatric nurse. Medication helps by balancing emotional ups and downs and may include antipsychotics, antidepressants, anticonvulsants and a number of others. Finding the right medication or combination thereof may take some time; however, it will be worth the wait. Alternative therapies that can be used in conjunction with prescription medications include massage therapy, acupuncture, certain herbs, yoga and tai chi.

The exact cause of bipolar disorder is unknown, but it appears to occur more often in relatives of people who also have the disorder, suggesting a possible genetic component. The condition, once known as manic depression, causes mood swings that can occur several times a day or once or twice a year.

There are three subtypes known as type I, type II and cyclothymia. The severity of symptoms varies from person to person and is based upon which type of disorder he or she has. Cyclothymia is the mildest type that can include disruptive depression and hypomania, a condition of overexcitement. Subtype II may be associated with irritability and periods of depression. Bipolar I is associated with manic episodes that can be both dangerous and severe. A person may have difficulties at work, school or interacting with other people. Depression, manic symptoms and hypomania can also occur at the same time, and are known as mixed episodes.

Symptoms for the bipolar patient might range from agitation, ADHD, irritability, risky behavior, rapid speech, poor judgment and performance at work or school, to periods of euphoria, an increase in physical activity, increased urges to perform specific tasks and an increase in sex drive. The depressive phase may include sadness, suicidal thoughts, anxiety, insomnia, fatigue, loss of interest in one’s surroundings, an inability to concentrate and feelings of guilt.

In order for a person to be diagnosed as bipolar, he or she must meet the criteria established by the Diagnostic and Statistical Manual of Mental Disorders (DSM) as published by the American Psychiatric Association.

In simple terms and depending on the subtype, a cyclothymic disorder must last two years or more with several hypomanic episodes and periods of depression but without a full manic, major or mixed depressive event. Bipolar II is based on at least one major depressive and at least one hypomanic episode. Bipolar I is based on having at least one manic or one mixed episode.

Manic episodes are defined as abnormally and persistently expansive, elevated or irritable moods that last a week unless hospitalization is necessary. Then there are symptoms a psychiatrist will look for to further substantiate the diagnosis.

Hypomanic episodes are defined as moods of worsened irritation that last at least four days and are distinctively different from the usual nondepressed mood. Again, specific subrequirements must be met.

With major depressive episodes, a person must undergo five or more specific symptoms over a 14-day period with specific features being met. Mixed-episode diagnosis is based on manic and depressive events nearly every day for at least seven days.

Because your son’s care should be under the direction of a psychiatrist, I am sending you a copy of my Health Report “Medical Specialists.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order made payable to Newsletter and mailed to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.