bipolarWe’ve recently been re-reading some of the works of Hagop Akiskal, one of the most important writers about Bipolar of the last 50 years.  He is particularly focused on identifying sub-types of bipolar as well as exploring the relationship between bipolar and creativity.  We were particularly struck with his description of type 4 bipolar.  This is someone (he says usually a man) who has what he calls a hyperthymic temperament.  By this he means someone who has always been very successful at work and in business relationships.  Someone who is high energy and often quite creative.  The example that my colleague came up with was Bill Clinton, not sure if that’s accurate or not.  But it gives you some idea of who Hagop is describing.

Such a person does not generally come in for treatment until he or she develops a depression, usually later in life.

As Hagop points out, someone who has always been filled with energy, enthusiasm, and creativity often is hard pressed to tolerate even a small amount of depression.  He or she comes in for treatment with a great sense of urgency about getting well.  Hagop proposes that this type of bipolar, when depressed, maybe at particularly high risk of suicide because of that difficulty adapting to or tolerating the change.

The good news is that treatment is often very effective, although as with all treatment of bipolar depression, it may take many weeks to see the good results that can eventually be achieved.

We’ll be describing some of the other types over the course of the next week or so as we review some of the material that we presented recently to the residents in psychiatry at the University of California, San Francisco as part of their course on Bipolar Disorder.