Go Easy on Meds, Says Expert

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Psychiatrists often fail to distinguish between mild mania and severe mania in treating patients with bipolar disorder, says the author of a new book.

Psychiatrists may be overshooting their targets in some patients with mild mania. This is the view of John Gartner PhD, an associate professor of clinical psychiatry at Johns Hopkins. He was speaking in an exclusive interview with the internet publication, McMan’s Depression and Bipolar Weekly.

Dr. Gartner is the author of the new book, The Hypomanic Edge: The Link Between a Little Craziness and a Lot of Success in America.

Hypomania is a form of mild mania that may involve hyperactive and risky behavior, but which can also result in unusually high productivity and creativity. Dr Gartner's book chronicles a number of illustrious American personalities with this temperament, including founding father Alexander Hamilton and geneticist Craig Venter.

Most bipolar patients experience mania only in the milder form (hypomania). They are diagnosed as bipolar II as opposed to the more severe form of the illness, bipolar I. It used to be thought that bipolar IIs comprised a small minority of bipolar patients, but new findings indicate that bipolar IIs greatly outnumber bipolar Is and are often misdiagnosed as having depression. Unfortunately, the medical literature is virtually silent on bipolar II and hypomania.

Said Dr Gartner: "The most common form of this disorder is being treated as if it were a rare weird variation."

Dr Gartner also advised: "When psychiatrists become aware that the patient has hypomanic symptoms, then I think their tendency is to over-react, react as if it is the same as mania, which it is not in terms of the risk and the danger."

Some people can obviously benefit from medication, but Dr Gartner makes it clear we are talking of the equivalent to microsurgery involving careful microadjustments "to take the edge off of the edge." This involves doctor and patient gradually inching toward that vital “sweet spot” that feels right to the patient.

Unfortunately, he said, psychiatrists trained to treat severe mania tend to overshoot, prescribing high doses based on clinical trials involving bipolar I patients. This often results in depression, weight gain, loss of libido, and cognitive dulling. Frustrated patients wind up quitting on their meds, sometimes with disastrous consequences.

The goal of treatment, concluded Dr Gartner, is "to make that person feel happier, healthier, more productive, and more like themselves."

McMan's Depression and Bipolar Weekly is the only internet Newsletter dedicated to mood disorders. The complete article can be found at http://www.mcmanweb.com/treat_hypomania.htm

Dr Gartner's website is http://www.hypomanicedge.com


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