Q:  Any Written Tests for Soft Bipolar Disorder?  What is the Treatment for Soft Bipolarity?

My psychiatrist thinks that I may have soft bipolar disorder.  He has been treating me on and off for approx. 5 years.  I was originally diagnosed with depression and anxiety.  After seeing my doctor and taking Effexor, Atenolol and Ativan for 18 to 24 months, I was symptom free.  We both agreed to stop taking the medications.  I was  symptom free for approx. 3 years.  Approx. 8 months ago I had a relapse.  I have switched to Cymbalta (90MG) and back to taking the Atenolol and Ativan as well.  I am concerned about my condition as I am a deputy sheriff and am worried that this condition may get worse and don't want to lose my job.  Is there any written test for soft bipolar?   What is the best medications for soft bipolar? I would appreciate any help or advice you may have.
 

Dear Chris -- 

There is no really reliable test for "soft bipolar disorder".  Any given result could be interpreted as a true positive, or a false positive; or as a true negative, or a false negative, if the test said "no, you don't have it".  However, to answer your question, there are two paper-and-pencil tests that are available, if interpreted carefully in discussion with your psychiatrist (not on your own).  One is the Bipolar Spectrum Diagnostic Scale.  The other is the HCL-32.  In both cases, I think the best way to use these tests is to look at the items which really strike you as applicable to you, and discuss those with your psychiatrist. 

In general, "soft bipolarity" is treated in the following way, because of circumstances: the patient is already on an antidepressant.  When the diagnosis is considered (i.e. some degree of bipolarity), particularly if several antidepressants have been tried and did not work, or are no longer working, one then turns to the treatment approaches used in bipolar disorder.  In practice, this means adding a "mood stabilizer" to the antidepressant.  If there is a dramatic improvement, I generally then try to taper the antidepressant, very slowly (e.g. 4 months, 25% per month), to keep things as simple as possible and find out whether the mood stabilizer alone can produce a solid stable result. 

Which mood stabilizer?  There are quite a few choices.  You'll find them discussed in the treatment section (start with that link, take the version for patients and families, and navigate to the treatment page) of my website, with a more comprehensive list on my mood stabilizer options page.  This may help you participate more fully in a discussion with your psychiatrist about which one to use, and how. 

Good luck with that --
 

Dr. Phelps