Dear Doctor

From the desk of James Phelps, M.D.
Corvallis, Oregon

Believe it or not, I’m not doing this to make money. You’ll have to read on a bit to see why. Your patient has brought you this because he/she thinks you can help, knowing:

• You each have the same goal: for him/her to feel better and function better.

• Some forms of depression can be made worse with antidepressants.1

Bipolar disorder has multiple variant forms that can be difficult to recognize.2

• Patients with bipolar disorder go an average of 7.5 yrs before being correctly diagnosed.3

Your patient has been looking around the Internet and found my site on Bipolar variants. This site includes only data-based, rigorously referenced, widely accepted medical viewpoints — no hocus pocus, no fuzzy thinking, no wild opinions. There’s no big money in this for me. I’m just trying to help you and your patient reach your goals (if you find that hard to believe, please see the explanation on my site: ).

By bringing you this letter, your patient is saying “I think I might have a Bipolar variant”, or that it needs very cautious “ruling out”. Bipolar Disorder has recently been recognized as having complex variations. It’s not just “manic-depressive” anymore. Patients who have depression, but who also have profound anxiety, or severe insomnia, or marked irritability, may have “Bipolar II”: a variant which does not maintain responses to antidepressants (e.g. “Prozac poop-out”), can be made worse by antidepressants, and can respond well to “mood stabilizer” medications.

Please consider my guide to bipolar variations for clinicians (hx, dx, rx, px), which may help you with this patient, found at . I wish you well with your further efforts at treating patients with mood disorders, knowing that “at least half of patients with psychiatric disorders make their only contact with the health care delivery system through the general medical sector.”4

James R. Phelps, M.D.

References (on the website you can access the actual references with a click)

1. Kilzieh N, Akiskal HS Rapid-cycling bipolar disorder. An overview of research and clinical experience. Psychiatr Clin North Am 1999 Sep;22(3):585-607

2. Fawcett J Bipolar Disorder: On the Edge of DSM-IV. American Psychiatric Association meeting, 1997

3. Ghaemi SN, Sachs GS, Chiou AM, Pandurangi AK and Goodwin FK. Is bipolar disorder still underdiagnosed? Are antidepressants overutilized? J Affect Disord 1999 Jan-Mar;52(1-3):135-44

4. Wells KB: Depression in general medical settings. Psychosomatics 35:279-296, 1994.