PTSD and the Lingering Effects of Bipolar Disorder

Reader’s Question

A friend was diagnosed with Post-Traumatic Stress Disorder (PTSD) years ago. The psychiatrist treating her prescribed Zoloft. After that, she got very hyperactive, couldn’t eat or sleep, and lost TONS of weight in a short time. She also TALKED a mile a minute. She had to come off the Zoloft because her symptoms were so extreme. The doctor then told her she would just have to “live” with the symptoms of PTSD. But when she got off the Zoloft she started struggling with concentration and thoughts of death. She had some depression but nothing severe, and she paid privately for therapy until she ran out of money.

Later, she began having more problems sleeping, increased problems concentrating and started having mood swings she thought were due to menopause. She saw a counselor and reported the death obsession and recurrent/periodic troublesome suicidal thoughts, but the counselor said a hysterectomy would relieve the psych problems. She had the hysterectomy. Six weeks later, she nose-dived — lost 45 pounds, didn’t wash, isolated herself, didn’t clean the house, stopped paying bills, and stopped interacting. Her mother said she was like a different person.

She got down to 85 pounds and became suicidal. She even discussed suicide plans. She stopped herself once. She didn’t seek help because she said she didn’t feel any emotion that was normal and didn’t feel connected to anything. Two weeks after that she did attempt suicide with an overdose, and she is permanently injured (liver and kidney damage) as a result.

My friend has since found out she has Bipolar Disorder. Is this type of huge crash common in untreated Bipolar Disorder? Is it likely that she had so much problem with PTSD because of Bipolar? I read about SSRIs causing bipolar folks to turn manic. Could that have been what happened years ago? Finally, is a hysterectomy likely to make a crash worse because of the loss of estrogen? Could that have figured in? She just feels so horrible about herself because she couldn’t see how badly she needed help. Lastly, just what is Bipolar Disorder? Is it a medical/biological “illness” or just the result of bad coping skills?

Psychologist’s Reply

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Your friend’s conditions appear serious and complicated and as such require sophisticated professional assessment. But some of your questions about Bipolar Disorder, PTSD, and the various treatments available warrant some discussion.

Sometimes also known as manic-depressive illness, Bipolar Disorder is characterized by an instability of mood that can include swings between periods of near normalcy, hyper-elation and depression. Today, two different subtypes are recognized. In Bipolar I Disorder, a person has suffered at least one full-blown manic episode, where mania is generally characterized by a distinct period of elevated, expansive, or uncharacteristically irritable mood and is often accompanied by increased energy, a decreased need for sleep, and impaired judgment and impulse-control. Pressured speech and “racing” thoughts are among the cardinal symptoms and signs of mania. In Bipolar II disorder, a person has suffered a depressive episode and one or more periods of hypomania (manic-like symptoms that fall short of the criteria for a full-blown manic episode).

The exact causes of Bipolar Disorder are unknown. It’s fairly well established that there is a genetic predisposition to the disease. There are also studies that suggest structural anomalies in certain areas of the brain. Treatment typically involves attempting to normalize mood and alter brain biochemistry through the use of mood-stabilizing medications. Bipolar Disorder can be difficult to diagnose accurately in the absence of clear and intense symptoms or signs. Other conditions can mimic the disease, and it can also co-occur with other mental illnesses. An underlying predisposition to the disease can be present, only to surface when triggered by exacerbating factors.

Treatment of Bipolar Disorder can prove challenging as well. Individuals vary in their responses to the types of medications commonly employed. And because other conditions can accompany and/or exacerbate the disorder, it’s critical to get comprehensive professional assessment and treatment.