Obsessive and depressed -- diagnosis?
Q: I AM 60 YEARS OF AGE,I AM JUST ABOUT TO RETIRE, I HAVE SEEKED MEDICAL
ADVICE WHICH STATES THAT I HAVE DEPRESSION AND COMPULSIVE THOUGHT DISORDER.
THOUGHTS OCCURED 21 YEARS AGO AND KEEP REOCCURING. PAST THOUGHTS HAVE BEEN IN A
SIMILAR NATURE TO THIS:- WORRYING ABOUT HARMING CLOSE RELATIVES DUE TO THIS
DEPRESSION. CAN YOU OFFER ANY HELP, TECHNIQUES OR ADVICE. IF NOT COULD YOU POINT
ME TO A MORE SPECIALISED WEB SITE YOURS SINCERELY MAUREEN.
Dear Maureen --
Trying to make a subtle diagnosis in this situation would be a poor idea,
over the internet. So you will need to hunt down a good diagnostic
psychiatrist; a university medical center will have one. After that you
can work with someone closer to home for treatments that may have been
On the basis of what you have written the three main diagnoses to be
considered would be:
1. "Major depression with psychotic features". This is
quite common and very treatable.
2. Obsessive compulsive disorder. Any time somebody talks about
obsessive thoughts, this diagnosis is going to come up. If you have some
procedures, activities or ritual behaviors that you can do to make the thoughts
go away, this diagnosis becomes more likely; but you can have OCD without such
3. Bipolar disorder. In my view this diagnosis doesn't come up enough
in the context of symptoms like yours. Technically yours would be
"bipolar II". You can read more about that at www.psycheducation.org
. However, its' a good deal trickier to treat than major depression; you
don't want it to be this, unless it really is this, in which case treating it
like major depression could make it worse, actually. So that's why that
first diagnostic step is so important.
The good thing here is that you're asking about a diagnosis and looking for
some help. Don't stop now, because all three of these are very
treatable. It could be something else, including some other medical
illness now making your old symptoms worse, but from the way you describe it, I
would doubt that. Ask about a medication called risperidone, which in
older folks such as yourself can work splendidly in tiny doses like 0.5 mg total
per day (where the full 20-year-old's dose can be 6 mg. or more). It might
be just the thing, because making a diagnosis here is going to be a little
tricky -- but risperidone could be a good treatment for any of them! (at least
Good luck and good hunting.
Published January, 2001