James Phelps: The Complexity of Mixed States

James Phelps, M.D. has specialized in bipolar spectrum variations for over 15 years. He has authored multiple peer-reviewed articles on mood disorders, and serves as Bipolar section editor for Psychiatric Times. His no-profit website, PsychEducation.org, focuses on complex bipolar variations; it has received over a million visitors. He accepts no honoraria from pharmaceutical companies, but does receive royalties from McGraw-Hill and W.W. Norton for books on the bipolar spectrum. A Spectrum Approach to Mood Disorders, 2016 from Norton, is for professionals; Bipolar, Not So Much , also 2016 from Norton, is for patients and families. Dr. Phelps received his M.D. from Case Western Reserve University, and completed his residency in psychiatry and a fellowship in medical education at the University of New Mexico. Current work focuses on primary care psychiatric consultation.

[@lambd01d]

If bipolar moods aren't mutually exclusive, then bipolar is a misnomer and the former usage of manic depression is more accurate, because they're not really poles.

[@millstreetteut7835]

Its an honour listening to you Dr. Phelps. I never met a psychiatrist getting it as accurate as you do!!

[@BackBrainKicks]

You're doing God's work Phelps. I've read both of your books. They have helped me very much with all of these diagnosis that "look" the same. Keep up your great work sir!

[@MarsianForestcat]

The diffrence between depression with mixed features and mixed mania is the mania. You can expierence hypo-/mania and depression at the same time. And I mean the mood state.

[@richardlewis1006]

I found this so helpful. It really explains the complexity of how bipolar affects me personally. The tips re light and dark therapy are something I will try, and explains a lot, particularly as the last 7 major crashes since 1991 have come in January. Thank you for posting and I will follow James Phelps from now on.

[@Susan-vn4ez]

10:14 wow that explains it 15:13 woww I've been speculating this for awhile, glad to know I'm crazy. The way I sae it was, you can have major depression AND bp2. So lows are LOW and highs arent as high as a result.

[@anaphaxeton]

Bupropion is a dopamine reuptake inhibitor. It is supposed to be one of the least mania inducing compounds. Some people can have real post-synaptic D2 excitation causing psychosis, not manic psychosis necessarily.

[@LCbr1j]

Very interesting & educational I appreciate how he addresses the complexities in the degrees of medicine & the medical needs. I have a older sister that has these issues but this time around I can not be involved in helping her much it is excruciatingly exhausting & she won’t even Answer her phone for the people that are trying to set up appts to help her.

[@kimfox8622]

I'm bloody confused and very agitated listening to this.

[@TEE19622]

More of a spectrum type approach is better on both those trying to diagnose as well as patients who have no clue initially with so many factors which are characteristic of so many different disorders. The similarities of adhd anxiety bpd bipolar 1, 2, nos, w/ schz tendencies, schizophrenia, hypomania, mania , am i missing any? And so many factors cause amplification or ...anyway spectrum makes ones less generalized and open to more meds and treatment options are helpful. We with bipolar 2 dont like taking meds but accept that the labels lead to getting the right med insted of fighting twice as hard aginst a misdiagnosis like the common diag of anx/dep and have antidepressants ramp to full blown mania and probably shortening lifespan.

[@jocs8824]

Isn't Valproic Acid better for the hypomanic or mixed hypomania treatment and lamotrigine with low dose lithium better for the depression symptoms in mixed states? Thus using both together in someone who often cycles between or is in mixed states often is needed?

[@nickdorfnus]

always a fan of your talks; what is the general "episodic" nature of mixed states? Is this something that tends to come and go? or if it is something that is, say antidepressant induced, does it become more of a chronic thing

[@VelvetCrone]

thank you!

[@DaughterOfChrist1997]

17:00 looking at the spectrum. So BP NOS is less ‘polar’ than type 2?

[@PalestinianCactusFlower]

Retry lamictal after a rash?

[@GTass455in]

Aida Qasim talked to my doctor about this... I’m just a patient not an expert. How fast did you ramp up the lamictal? My doctor said we would do ours very slow like 25 mg/d increasing by 25 mg/d every two weeks. My doctor said the skin issues are triggered by the initial dose, as the presenter here mentioned. If you went faster than that, then you could probably try it again. What did your doctor think?

[@marc2377]

Dr. Jim has an answer for you here: psycheducation.org/treatment/mood-stabilizers/the-big-three-for-bipolar-depression/lamotrigine-lamictal/details-on-the-lamotrigine-rash/

[@Jake-ny2kf]

someone has Dr. phelps email?

[@PalestinianCactusFlower]

Do you recommend retrying lamictal after a rash?

[@MarsianForestcat]

I know your question is a year ago but that's a very good one. I got a rash after taking it 2 month. I was not too happy because lamotrigine works for me very well for mixed state. Now I take lithium wich is not recommanded for mixed states. Works but doesn't works as well as lamotrigine. Lithium obviously is very slow.

[@nickdorfnus]

lurasidone now generic, good times

[@dodgdurango6128]

I love the keyboard psychologists here. differences between illnesses would be the sleep.

[@TEE19622]

Naturally occurring antidepressants (ask google) should be a first go to ...not specific and rare ...teas. spices, variety of life, pushing yourself to do things your are resistant to. GOOD sleep, are critical. Routine and regulation need to be moderated with spontaneity and progression. The spice of life is not staying still for too long.

[@ergotoxicosis]

@Brittany Goodfellow can you please describe what a mixed state is like?