Hi, My mother is 61 years old and she is being taking Prozac for the past 4/5 years. It seems that she didn’t have any improvement. She is getting more depressed and tried suicide 3 times. I read an article saying that if a person who has Bipolar Disorder is being treated for Depression the consequences can be bad. What type of exams I can ask her to do to make sure she has a perfect diagnosis of her disease? She lives in Brazil and I live here, in the US. Thanks in advance for your help. Regards, Aline
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Bipolar Disorder and Depression are both depressive disorders. They are both characterized by the presence of major depressive episodes; period of time characterized by rather extreme depressive symptoms. Standard depressions (sometimes called Unipolar depressions) are defined entirely by the presence of major depressive episodes. However, Bipolar Disordered patients do not remain stable in their depressive episodes, but also swing in the other direction, into a state known as mania which is the energetic opposite of depression. Mania can be quite dangerous in its own right, just as can be depression.
The reason that it can be bad when someone with Bipolar Disorder takes antidepressants is becuase antidepressants can precipitate (cause to occur) mania. Many antidepressant medications can precipitate mania in a patient who is vulnerable to mania.
Your question has to do with how Bipolar Disorder is diagnosed and whether you have cause to worry about your mother’s care. To get the full picture, I recommend you read our Bipolar Disorders topic center. In a nutshell, however, I’m not aware of any particular test for bipolar disorder which is definitive. Generally, bipolar is diagnosed based on a history which records defined swings between periods of depression (mild or major) and mania (mild or major). Similarly, unipolar depression is generally also diagnosed based on history, but in this case, a history of only depressive symptoms.
A newly diagnosed depressive patient might be considered a suspect for bipolar disorder on the basis of there not being any history at all to reference. A thoughtful treating doctor might be careful with antidepressant dosing with this thought in mind (so that any signs of mania can be caught early if they develop in the wake of the drug). When there is a long recorded history of only depression and no trace of mania, however, it is fairly safe to assume that there is no bipolar condition present. Only a licensed mental health doctor is in a real position to accurately diagnose depression or bipolar disorder.
There are many different antidepressive medications in use today, and they may be prescribed either singlely, or in sets of multiple drugs. It is often the case that a patient’s depression does not optimally respond to the first drug that is tried, and multiple combinations of drugs may be tried before an optimal cocktail is hit upon. Your mother may not have received the correct dosage, or been offered the various combinations of drugs which will be necessary for her to best respond.
You also need to know that depression is not something which can always best be treated with drugs alone. Cognitive behavioral psychotherapy can be a helpful adjunctive treatment along side drugs for some patients, for example. There are other cases where despite doctors’ best efforts, no combination of drugs or doses can be found which makes a significant dent in a patient’s depression. Under such circumstance, alternative treatments, such as electroconvulsive therapy (in its modern safe format) can be tried, often with good success.
It will be very difficult for you to manage your mother’s care from a continent away. I wish you luck in making progress, however, and for relief for your mother.