Q:  Does Hypomania Imply Bipolar

A family member was recently diagnosed as having hypomania.  He was becoming depressed and was prescribed fluoextine capsules (30mg), whilst simultaneousley taking dihydracodeine for back pain (30mg)   Hyper behaviour followed as did a  brain seizure.  We are keen to understand what causes hypomania and whether this implies manic dpression.  This family member suffered from severe depression 15 years ago and was in hospital for a considerable amount of tim, there has been no relapse in this interum period.

Could you please give us some information.

Kind Regards
Maureen

Dear Maureen -- 
Tricky: this is technically what's been called "bipolar III" (as opposed to bipolar I and II), namely "hypomania only in the context of an antidepressant".  We have enough trouble in my business getting agreement about whether to avoid antidepressants in bipolar II, where the risks are well known for some patients.  Getting agreement as to whether this man's experience actually "means" he has "bipolar disorder", as opposed to meaning that he should just avoid or use great caution if he ever takes an antidepressant again -- there is not agreement in my field about this.  Should he, for example, be treated with a mood stabilizer as we would were he clearly "bipolar"?  Or, if that's already underway, must he continue it as we recommend nearly all the time for people who are clearly "bipolar" -- ?  No agreement on that in the field, as I see it.   

Dr. Phelps