Welcome to Bipolar in Focus. I'm Jane Pauley.
Maybe you've heard the terms "switching" or "flipping" into bipolar. Dr. David Kahn of Columbia University and New York Presbyterian Hospital is with us.
It is becoming more common that someone who was not bipolar under the effects of a medication for something entirely unrelated is suddenly flipped into a mania and that's what you call switching?
That can be a medically or a medication induced switch into mania and we see this with a number of different types of medications.
Now of course, if someone has bipolar illness and no one knows it and they're given antidepressants when they are depressed, that's a common cause of switching into mania.
Why would someone have bipolar and we don't know it?
Because the manic episodes maybe recalled as relatively pleasurable particularly if they were on the mild side and the person won't think to tell the doctor that,
"Hey, I was hypomanic or I was manic."
So unrecognized or perhaps without a family history?
If someone comes in for depression and has no family history of bipolar illness, it's less likely that antidepressants would make them manic.
But if they do have a family history of bipolar illness, or if we can take a very careful history of that person and detect possible past episodes,
we often might be more cautious in our use of antidepressants.
And caution is called for because?
Antidepressants can switch a person who has undiagnosed bipolar illness out of depression into mania instead of just putting them back into a good, normal and healthy state of mind.
Many people are prescribed antidepressants by what they refer to on television sometimes now is you're a prescriber which may or may not be a doctor trained in pharmacology.
Are all the prescribers aware of certain medications that might have this effect in a patient they don't know that well?
We certainly hope that we're able to reach prescribers;
both primary care physicians who see most people who have depression, nurse practitioners and other health professionals who may prescribe antidepressants.
They are sometimes used for example as part of pain management.
So it's important when anyone takes an antidepressant that the doctor or the nurse treating them looks to see if they might have risk factors that would be clues to bipolar illness.
Well, thank you Dr. Kahn. And thank you for watching Bipolar in Focus.