Dear Dr. SerVaas: My sister was just diagnosed with a case of hypomania and bipolar disease.She is 45 years old and had never known she had bipolar disease. However, she was given steroid medications for arthritic pain.

Is there a chance that the steroids caused the bipolar disease to surface?

She was given an antidepressant when she became depressed about a year ago and before her "manic" period that brought on her diagnosis.

We believe our grandfather was perhaps bipolar before he died. He was a member of AA after having suffered from alcoholism for many years.

Marjorie Anderson
Tulsa, Oklahoma

Dear Reader: Bipolar specialist and researcher Dr. John Nurnberger of Indiana University responds:

"This is quite possible, not at all uncommon. Steroids are often associated with behavioral symptoms, and hypomania or mania is probably the most common syndrome seen (depression and/or psychosis are also possible). It seems to be a dose-related effect, seen especially at doses over 40 mg of Prednisone per day for two weeks or more. Mania following antidepressant treatment is also well documented. A careful history at the time of the depression may have disclosed the previous hypomania and suggested the use of a mood stabilizer like lithium instead of the antidepressant.

On the other hand, the history of hypomania may be difficult to get; often people are unaware of hypomanias, or deny them. Sometimes it's only in retrospect that they realize that they were in an unusual state; sometimes after someone has gotten used to the diagnosis of bipolar disorder, they may be able to look back and see hypomanic periods in their earlier life."