Dealing with Bipolar Disorder and Depression


Q1. Are there any bipolar medications that do not affect you sexually?

— Andrea, Texas

A recent, very large study determined that about 39 percent of people who take selective serotonin reuptake inhibitors (SSRIs), the most commonly prescribed type of antidepressant, do experience sexual side effects. Of these, the highest rate of sexual dyfunction was reported for paroxetine or Paxil (43%), whereas lower rates were reported for buproprion (Wellbutrin) and nefazodone (Serzone).

However, SSRI antidepressants have not been found to be particularly effective for bipolar disorder. Mood stabilizers like lithium, valproic acid (Depakote), and lamotrigine (Lamictal) are typically the first line of treatment for bipolar disorder. For these medications, sexual side effects are much less commonly reported.

Q2. I am a 42-year-old male with bipolar disorder. I have been, so far, successful at treating things since 2002; my last hospitalization was in 2004. For about five or six months now, I have had a very increased sex drive, and it doesn't seem to be slowing. I have so far been able to resist acting on my mind’s desires. I was wondering, is this normal? I take Topamax as my mood stabilizer and occasionally have to go on Risperdal (risperidone) when I get paranoia. I am wondering if perhaps I am living in a hypomanic state. I have lost about 35 pounds, and my sleep is sporadic at best.

Given your increased sex drive and poor sleep, it does sound like you may indeed be experiencing subthreshold manic or hypomanic symptoms. Topamax (topiramate) is frequently associated with weight loss so that may be partially responsible, although 35 pounds is a lot.

Do you have a psychiatrist or doctor that you see regularly? It is important to discuss your concerns with the physician prescribing the Topamax for you, as you may very well need a medication adjustment.

What are your family and friends saying? Have they noticed anything different about you? This can be a useful yardstick of whether your behavior is beginning to spiral out of control. Decreased sleep often precedes onset of a manic episode, and so it’s extremely important that your doctor is aware of the current symptoms you are experiencing.

Q3. Back in the '70s, I was diagnosed with depression but never with bipolar. I am now 56 years old and have started menopause. I started hearing voices and imagining people were following me. I have so many highs and lows, I feel like I'm on an emotional roller coaster. Everything seems to depress me, but the doctors I have been to only call it depression. Why is mental health not taken seriously enough? It is a very serious matter, and it's hard to understand. I have a son who is bipolar, and he has attempted suicide so many times, but as for me I have only had thoughts of suicide. Let me tell you this is a very scary thing because I don't know if I'm having a breakdown or not.

It sounds like you are experiencing psychotic symptoms during your mood episodes, which I’m sure is extremely frightening. While psychotic symptoms can occur during a depressive episode, they warrant special attention and may require treatment with different types of medications.

There is some research suggesting that estrogen may protect against the development of severe mental illness in younger women, and thus menopause may be a period of increased risk for the development of these disorders. Do you have a relationship with a psychologist or psychiatrist? If not, now would be a good time to seek someone out so that you can address the changes in your symptoms.

It is extremely important for the sake of both you and your son that you have some good treatment in place. Unfortunately, you are right that mental health treatment often comes last or is completely ignored.

Q4. I am a 49-year-old female, suffering through menopause. I have just been given Activella, but it doesn’t help with my symptoms. In delving into the Web for information about the depression aspect associated with my menopause, I believe that I also suffer from bipolar disorder (as does my dysfunctional family). Does menopause significantly impact the symptoms of bipolar disorder?

Activella, or estradiol/norethindrone acetate tablets, are a common treatment for symptoms of menopause. However, estrogen treatments for menopause have been associated with certain health risks, such as increased risks of myocardial infarction (heart attack), stroke, invasive breast cancer, pulmonary emboli, and deep vein thrombosis in postmenopausal women 50 to 79 years of age, over five years of treatment.

These treatments have also been associated with an increased risk of probable dementia in women 65 years or older, according to a long-term national health study called the Women’s Health Initiative.

Perimenopause – the transitional period leading up to menopause – is associated with emotional symptoms like fatigue, irritability and rapid mood swings, so that could certainly exacerbate existing mood disorder symptoms. There is some evidence in the research literature suggesting that periods of hormonal change represent a major trigger for bipolar episodes in some women.

Tell your prescribing doctor about the symptoms you’re having so you both can carefully weigh the risks and benefits of remaining on Activella, particularly if you do not feel like it is helping with your menopausal symptoms. These are important facts for your doctor to be aware of, as you should monitor your mood symptoms very closely during this difficult time to ensure that you are treated effectively. You may need a referral to a psychiatrist, who can help properly evaluate your symptoms and recommend treatment if necessary.

Learn more in the Bipolar Disorder Center.