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David Mrazek, M.D.
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David Mrazek, M.D.
David Mrazek, M.D.
Dr. David A. Mrazek is chair of the Department of Psychiatry and Psychology at Mayo Clinic, Rochester, Minn., and a professor of psychiatry at College of Medicine, Mayo Clinic. Dr. Mrazek has developed a federally funded psychiatric pharmacogenomics research program and implemented clinical psychiatric pharmacogenomics services at Mayo Clinic.
He has received numerous awards including the Award for Creativity in Psychiatric Education from the American College of Psychiatrists and the Agnes Purcell McGavin Award for Distinguished Career Achievement in Child and Adolescent Psychiatry from the American Psychiatric Association. He currently serves as chairman of the board of the American Board of Psychiatry and Neurology.
Dr. Mrazek has focused his current efforts on using pharmacogenomics testing to improve clinical care. One of his specific goals is to decrease the risks of taking psychiatric medications.
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Depression blog
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Aug. 22, 2008
Bipolar isn't simple; there can be many sets of symptoms
By David Mrazek, M.D.
Bipolar affective disorder is a disorder of mood that involves a depressive phase and a nondepressed or manic phase.
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The specific set of symptoms is important as some medications, such as Lamictal, are better for a mixed bipolar episode. Medications used to treat bipolar (mood stabilizers) are different than medications used to treat depression.
The manic phase is characterized by elevated or irritable mood plus 3 to 4 of the following symptoms happening during the same time period (at least one week continuously):
- Decreased need for sleep (feeling refreshed on little sleep)
- Decreased appetite
- Grandiosity (inflated sense of self worth)
- Distractibility
- Excessive involvement in pleasurable activities that have a high potential for painful consequences (buying sprees, sexual indiscretion, foolish business ventures)
- Flight of ideas (talking and thinking that jumps from one topic to another-racing thoughts)
- Increase in activities involving school, work or social life
- Agitation
The person may also experience psychosis, which means being out of touch with reality. The manic phase is a change in previous life functioning that is not caused by drugs or alcohol. The manic phase alternates with a depressive phase.
The Mood Disorder Questionnaire (MDQ) is a self-screening tool that can be used in conjunction with a visit to a mental health provider. Mood swings alone do not mean you have bipolar. Borderline personality symptoms can look like bipolar and other mental illness, too. Time and accurate information help to make the correct diagnosis and provide the best treatment.
128 comments posted
November 3, 2008 2:33 p.m.
i would like to comment on a comment listed, oct. 6th, take my comment for what it's worth. i've been married to a man just like the friend you describe. my husband and i have been married for 28 yrs. i thought i had lost my mind and my idenity. after much therapy and different diagnostic testing...i found a therapist who realized the problem wasn't me, the problem was my husband has what is known as a sociopath! 1 in 25 ordinary americans secretly has no conscience and can do anything at all without feeling guilty. their charm know's no bounds. seek a professional ie. to his or her behavior. i was shocked to learn a sociopath doesn't fit the mold i thought they did. read martha stout's book "the sociopath next door". you might recognize your friend!
- madhatter
November 3, 2008 9:24 a.m.
We have several bipolar/ manic depressants , alcoholics in our family 3 have no concept of money, do not work. Are these also syptoms of disease and is there any help?
- Janet
November 2, 2008 3:01 a.m.
This is a crock "disorder"! There is no such thing as bipolar. The problem is a poor diet and bad parenting. Of course your brain chemistry will change if you are not receiving proper nutrition and you have unresolved issues. I think people like having this label to justify their actions and to get sympathetic attention from others. My friend's daughter (age 6 at the time) was diagnosed with this crock of crap. I insisted she take her to see a non drug prescribing psychiatrist. He immediately put her on a proper diet. She was formerly being fed fast food, soda, boxed crap and various other lazy mom foods. In a matter of 7 days she was a completely different child. The change in diet wasn't the only issue, my friend was (is) a horrible parent. She paid very little attention to her child and was physically and mentally abusive. This friend was lazy and so it was up to me to provide her child with nutritious meals and emotional support. Her daughter improved under my care, but alas I had to dissolve this friendship as it was becoming detrimental to my own health. So, to all of you out there who has this crap disorder - *You are nutritionally deprived and too lazy to change your diet *Would rather take the easy way and pop pills instead *Use it as a excuse to behave as you wish without accountability *Want sympathetic attention because you can't get any other way.
- Quantum
October 30, 2008 12:23 p.m.
Concerned....Is it normal for a person who says they have bipolar type 2 disorder to have literally a sac of medications on them (about 20 in a cosmetic bag), obsessing about having cmv, chronic fatigue syndrome Epstein Barr virus, liver failure, etc... other unusual behavior include: secretively, raiding a fridge at 3 am and eating 2-3 tubs of ice cream a day, and staying up till 4 am, taking her medications when no one is around or not at all, maybe having about 4-5 different herbal supplements, eating applesauce yogurt and that's about it....random outbursts of energy then feeling not well all of a sudden, and no understanding of common manners ... this is a family member of mine. And I am concerned about their well being and that they are not being treated for their condition. I am not sure how to deal with this person and her son every time I confront him about his moms behavior he doesn't want to talk about it, like he is in denial about his mothers condition. She seems to lack simple commonsense. I do know in the past she has been in a mental ward and treated with Electro Shock therapy. Any suggestions. She lives in the middle of no where... and am worried she isn't taking any steps to get better...
- andy
October 29, 2008 8:07 p.m.
I read about the symptoms of depression and rarely do I read anything about the pain it causes. Sure, loss of appetite, mood changes etc are relevant but why is nothing said about the pain that is so overwhelming and cuts through the very fabric of my existence. Suicide is sometimes precipitated by the inability to cope anymore with the unbearable pain. I am not referring to someone with a pathological pain that exacerbates the state of depression, I am referring to the pain caused by depression itself. Am I alone in this experience or do I have something else besides depression? Yes, I do isolate myself from the world as I seem to be easily stressed which makes matters worse. I was a very prominent lawyer and one morning after many years of practice I just woke up with a total indifference toward my work or even my hygiene. That has been a number of years ago and I am still the same. My existence seems to be counter productive to what we usually view as a life. My children don't come around anymore, and they have the perception that I am simply lazy. I don't always feel this way an this is just one of those days, but for me the state of depression can be unbearable. My question has to do with this particular symptom, excruciating pain , is that part of the disease or something else? Bobby
- Bobby Joyner
October 27, 2008 1:06 p.m.
A forensic hospital may be an ideal option for your son. We are sorry to hear your son is having so much trouble. Unfortunately, it is very common for people to stop their medications. ECT can be used for mania as well as depression. I don't know if your son is a candidate for this treatment. This will not cure the bipolar, but can treat the mania. He will need to be on medications indefinitely, so continue to work with his providers on finding a medication he will take. Make sure to tell your son to speak up if he has unpleasant side effects. Take care.
- MC.Com Staff
October 21, 2008 6:48 a.m.
Hello, My Son is bipolar. He has been in and out the Hospital around 20 times. The Meds helps a little, I have informed the Doctors of this, hoping they would change the Meds,not until now, they are trying. He still has flight of thoughts,a decrease need of sleep, very friendly with strangers. Trust everyone except me. Before he was committed this time, He touched a lady with his hand, she filed charges on him. He was arrested and sent to the hospital.(For touching someone, Sexual Assault. On the 22nd of this month, his hospital stay will have ended.Then he will have to go to jail.Are there any long term care for Bipolar Patient? Oh yes, prior to this he had stopped taking his....His reason, he did not need them. My next question, do you think Jail is more suitable than a long term care facility? His Case Worker suggest a Forensic Hospital. Please Advise me what to do?
- Miss J
October 15, 2008 10:54 a.m.
Andra, Please call someone to get a mental health evaluation. We cannot make diagnoses on our blog. Your symptoms could represent several different conditions, so please see a professional. We are sorry that you are struggling. Please ask for help
- Mayo Clinic.Com Staff
October 14, 2008 10:00 p.m.
can someone awnser me please
- andra
October 14, 2008 9:57 p.m.
i been diagnosed with biopolar but i dont think i have ie i get mood swings likealmost every daymy moods change so often i dont have grandoise thoughts i can sleep never been manic i feel empty inside i get bored so easily some times the pain inside isso unbearable i take drugs to numb the pain andboredness i feel sometimes i dont know who i am i dont know thanks
- andra
October 6, 2008 3:45 p.m.
I have a question...I have a friend who has been diagnosed with depression, however I think it could be bipolar. On an average day he is wonderful. He has a great sense of humor and a wonderful smile, but even on good days he is a cronic liar and he never follows through with anything. Many of the jobs he takes or jobs he promises to do never get done. I know this because he has promised to me many times. His severly depressed times seem to come up when he needs to start facing reality. When this happens he can't get himself out of bed. He has been trying to run a business for 30 years and has failed time after time. He gives everyone the impression that he works all the time, when in actuality he doesn't hardly work at all. He has severe finacial problems and doesn't seem to really want to do anything about it. He has amazing family and friend support but it gets to a point where you just want him to get out of bed and figure things out. He stops taking his depression medication when he is feeling good. Does this sound like Bipolar?
- Jenny
September 29, 2008 10:20 a.m.
do you know if paranoia is part of the manic phase? Having to sleep with lights on, constantly feeling the need to check the house, feeling someone is in house.
- lisa
September 26, 2008 5:07 p.m.
After watching my daughter over 34 yrs I am convinced she has severe bi-polar. It is the only explanation for the many out-of-character behaviors, the days w/o sleep and incessant talking. She has delusions and now her family knows this for certain. I want to know why it is that so many of these daughters w/ this disorder end up being estranged from their good and caring families, particularly, the mother?? It is heart-wrenching for us, esp. as she also has been Dx w/ Lyme and therefore has much pain. She takes many strong meds for this. However, we realize that her 'stories' and behaviors have been going on since she was a preteen. She has her husband (2nd one) convinced that her mother is the worst kind and that she is only interested in "controlling" her life. This has never been true. Her brothers who love her dearly still cannot take being around her, neither can their wives as she is so controlling and seems to want the world to revolve around her. We know she is a good-hearted and intensely caring person and that is the one thing that makes it all so very painful. She is sincere! She thinks she knows our "real" motives and in her mother's case they have to be the worst. What is so sad is the fact of our very close relationship when she was growing up. She wrote many loving cards and even a very touching poem dedicated to me as I have struggled with the Tourette for all of my life & thru many tragedies. She wrote "I love you."
- Crystal Lee
September 22, 2008 11:46 a.m.
If you suspect you may have Bipolar, ask you health provider (Family Med, Internist, Ob/Gyn, etc.) to get you an appointment with a Mental Health provider so you can obtain a thorough evaluation. The treatment is different than treatment for depression alone.
- MC.Com Staff
September 18, 2008 9:10 p.m.
I'll be 63 this weekend and have been on Prozaac and Wellbuterin continuously for the past 7 years. As I have gotten older, the manic phase has lessened ahd I've been left with mostly depression. I welcome the manic phases so I can get stuff done. Really have to watch spending, though. My sense of consequences leaves when the manic comes in. I think they call mine Type II Bipolar. No rages or paranoia.
- Edee
September 16, 2008 4:06 p.m.
Hello! I have been reading the blog and postings. I have been diagnosed with depression, but have wondered for years if it is more than that. I have highs and lows. Sometimes i can feel myself talking and I can't seem to shut that off. I have had times in my life where I stay up for hours on end (I painted or wallpapered almost everything in my house between the hours of 1-4 am while also working 7 am to 4 or 5 pm during a span of weeks a few years back). Sometimes I feel as if the world is not moving fast enough for me and do have times of rage or extreme irritability (Ask my hubbie -it can be pretty awful and for no reason). I many times feel like I am not doing enough or that I am not liked by others, even if I have evidence to the contrary. I have been on antidepressants (Prozac, Zoloft, Zoloft and Wellbutrin, and Effexor now) and they seem to help me not cry or rag constantly, but things just don't feel right. I have dealt with this for almost 20 years with my first episode occurring around age 19. I have been under the care (at different times) 3 psychologist and 1 psychiatrist. At the moment, I am seeing no one and receive my meds from my OB/GYN. I know that bipolar is hard to diagnosis and that Bipolar today seems to be the "it" diagnosis, but with what I am describing, should I seek further help to see if it is, indeed Bipolar and not just depression? Any thoughts are welcomed! Cat, the potential cycler
- Cat, the potential cycler
September 12, 2008 11:06 a.m.
There is always a risk of precipitating a manic episode while on an antidepressant. The risk (no specific % available) is known to be lower when on BOTH a mood stabilizer and antidepressant at the same time. The risk seems to be lower with the newer medications versus tricyclics, but is not zero. Following closely with your provider and knowing the signs and symptoms of your illness are very important.
- MC.Com Staff
September 3, 2008 4:04 a.m.
this is a good summary of bipolar illness and i like the fact that ppl are encouraged to seek medical help with these symptoms. I think being bipolar and having generalized anxiety disorder is a mixed bag of symptoms. You just don't know how you will wake up without medication. The medication is very,very important and i know a lot of bipolar people who try to correct their symptoms without it through religion, exercise, diet, thyroid therapy. Please address the use of these alternative methods in place of medication, because I think it is dangerous to go without medication, in my own bipolar case.
- patsy
September 2, 2008 11:05 a.m.
To address a couple of comments - yes, bipolar can manifest as rage or anger during the manic phase. We did state this in the blog, but used the word irritability to mean anger or rage. Mania can present as euphoria or irritability (anger or rage)or a combination of the symptoms. (a mixed episode which is a combination of irritability/anger and depression or euphoria (significantly elevated mood) and depression) We hope this clarifies our statements about Bipolar.
- MC.com Staff
August 31, 2008 8:00 a.m.
can someone tell me what is chance of getting unipolar converted into bipolar there is always administration of mood stabilisers with antidepressants like escitopam but it is given in low doses in long run i believe that the therapy really helps to curb depression
- amit
August 30, 2008 6:40 a.m.
My sister-in-law is bi-polar she was diagnosed after her son was born and had to be hospitalized. It is very hard on the family. She had to be hospitalized a few times. About 2 weeks ago my brother found her in one heap in the garden and it was a sad sight and he told her that she needed to go to the hospital. She did not want to go and pulled herself together. I found it interesting that she could do that. She has a great dr and can call her anytime.
- Liz
August 28, 2008 7:41 p.m.
Hi - my exhusband was bi-polar. He was the love of my life, however, he stopped taking his medicine and had become impossible to live with (anger) and had stopped working. He is still in denial because he does not want to be bi-polar. He just wants to be ADHD and a problem drinker now and then. However, I went to the local hospital and checked out Medical books on ADHD and bi-polar. I needed to know for sure myself that the doctor was correct. He is definitely bi-polar - ADHD adults are not rebellious which my husband was. Other major traits that were in three bi-polar books confirmed my husbands behavior during the mania time: You are not suppose to contradict him He wants the immediate family to conform He does not care if he hurts your feelings Immature Self-importance Spending sprees Anger (rage) Big Ideas (inventions, etc.) Needs a lot of attention - it is totally about him. All alcohol changes his personality no matter how little he drinks. My husband had been on Depakote (mood stabilizer, however, I did not know at the time why the doctor was giving him this medicine. He was working again and was even tempered and his old sweet self. However, he stopped taking the medicine and the symptoms of bi-polar came back. It wasn't too long after that that I went to the doctor with him and the doctor told me he was bi-polar. My husband just asked him - "Couldn't I just have an anger problem"?. The doctor said "no". Take care....
- -Blessings
August 27, 2008 5:32 a.m.
Yes, I have a friend that was diagnosed with bipolar. I felt bad about it at first, but now I am only fed up with her. She sees a psychiatrist but won't take any kind of medication for it. She is either on a high or a low. She is ok with people when on a high, but when she is on a low she doesn't talk to her friends. Nobody can talk to her, she knows everything. She thinks we should be at her beck and call all the time. She thinks herself Queen Been. You cannot explain anything to her. Well she is loosing all her friends. I was very ill myself and she never bothered with me to ask how I was. Because it wasn't about her. I am frustrated and don't bother with her anymore because she doesn't want to help herself. Are these symptoms of bipolar?
- Patricia
August 27, 2008 12:30 a.m.
I come from a family with a long history of depression--from my paternal grandfather to my mother to me. I feel that I am the first in my family to be correctly diagnosised and sucessfully treated. I was fortunate enough to be referred to a wonderful female psychiatrist who on the first visit said to me, "Don't worry, we are going to figure this out. Just stick with me". I almost fell off the chair. I had never had a doctor say that to me before-let alone offer any kind of hope for getting better. I did stick with her although finding the right medication by trial and error was not easy. I think I must have tried every anti-depressant on the market until the one was found that worked for me. Then it took alot of "tweaking" to get the dose right. It took a year for the doctor to make the diagnosis of Bi-Polar I. She explained to me that if a person has more that 3 depressive episodes lasting more than 2 weeks in a year's time, she considered the person to be Bi-Polar. The medication I take now is Lamictal, which is considered a "cross-over drug" and is also used for patients with seizure disorder. I believe the key is to find a good doctor (psychiatrist) who is willing to work with you until you find the right medication. It is not always easy and it takes time. I am 59--married for 31 years. My husband hung in there with me. It is tough on spouses and marriages break up over this. Don't give up. There is good help out there. You just have
- Katherine
August 26, 2008 11:29 p.m.
I probably should not be posting here, but I do not know where to go. My wife is clinically depressed and will not acknowledge a problem. She is down to about 90 lbs and will not eat. I don't know what to do. Her doctor told me she did not want me to have access to her records. My wife is killing herself & I cannot do ... about it! I'm an Engineer by trade. I fix machines and systems every day, & I cannot help my wife. Please help me, us. Timothy
- Timothy J
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128 comments posted