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Bipolar and fibromyalgia?
Q: Dear Dr. Phelps,
There seem to be more and more women
with Bipolar Disorder who are being also diagnosed with Fibromyalgia.
Do you think there is a connection between the two?
Colleen
Dear Colleen
I've never seen a word in the literature
about this, but I've sure seen it in practice -- over and over. So, to
answer their question: yes, I see
the two show up together. In fact, in virtually all the "fibromyalgia"
patients I've seen, there is mood stuff too. Of course, I wouldn't be likely
to see FM patients who had no mood symptoms at all! But my rheumatologist
friend says he sees the overlap too. But the important point to me is that
the mood symptoms are much more likely, in my view, to have "bipolar" characteristics
(as opposed to unipolar): profound sleep disturbance, cyclic recurrence,
irritability and decreased concentration even when little "depression"
is present. Perhaps most salient: the FM symptoms seem to directly cycle
with sleep, almost as though in these women -- as they are nearly all women
-- the pain symptoms are just another "bipolar" symptom. i.e. the pain
*cycles* along with the rest of what we might typically regard as mood
symptoms. Think about it: what if "chronic fatigue syndrome", which also
co-occurs with FM and bipolar, was in some people just the depressed phase
of "bipolar", with it's characteristic profound lethargy and fatigue, without
obvious depression? As most patients know, the "mood dial" and the "energy
dial" don't always turn the same way at the same time; they're relatively
independent, at least in some people. Finally, why is that there is such
a predominance of women with FM? This is an obvious and crucial question.
I used to think it was because sexual abuse is so unfortunately common
in women. But I've seen women with no such history, nor any clear reason
to suspect some "repressed memory" either. I'm working on a "hormones and
mood" website where I'll try to present current research that relates to
this topic.
Dr Phelps
Published September, 2000
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