Q: Do I Fall in the Bipolar Spectrum?
Dear Dr. Phelps,
I've been suspected of having generalized social anxiety, add, and atypical
depression. I'm 23 and I had a major depressive episode when I was
around 16. Recently, I've researched the bipolar spectrum and think I
may have something worse than cyclothymia but not as bad as bipolar II.
My mood cycles sometimes within the same day but I'm never in what I call my
"up" phase for more than a day -- maybe two days on occasion. My
up phase is incredible. It's almost like being asymptomatic -- no
depression, limited social anxiety. Life is a pleasure, and being up
doesn't seem to get in the way of functioning but it doesn't last long enough
to know for sure. More of the time I'm somewhat down and socially
anxious, but on occasion I get way down with about the same time frame as my
"up" phase. I go through about one noticeable mood fluctuation
a week, and less noticeable within each day. My most noteable problem
with sleep is getting up in the morning -- getting me out of bed is all will
My response to anti-depressants (and some other drugs like adderall) has
always been WOW! This is incredible, I hope this lasts, but it never does and
I begin feeling worse. And so I stop the drug cold turkey and feel
really good again followed by really bad. Zoloft had the biggest effect
on my mood. Lithium made me very depressed and irritable, depakote made
my mood consistent but too far from happy.
I'm currently on moclobemide (RIMA) which seems to have accelerated my
fluctuation in mood but it has been helpful with social anxiety. I was
considering stopping moclobemide and trying Lamictal instead? What do
you think of Lamictal for someone with my symptoms? And do you think I
fall in the bipolar spectrum? Thanks for reading my words and
considering my situation.
Dear Jon --
From the unsafe distance of having read only your letter, I would agree with
your diagnostic assessment. If you're right, lamotrigine could be an
excellent idea; for your doctor's consideration, here's the handout I give
patients for that
medication and other. Check your thyroid status. You know from
experience what I recently heard from a bipolar expert: the opposite of mania
is not necessarily depression, or only depresssion -- it's lack of confidence.
Unfortunately that has proved harder to "land in the middle" than
mood, in my experience; so you might look down the road at a treatment program
for social phobia (ironic you'd need it when you clearly don't, one day a
month or so) if that's a major issue when mood and energy are no longer
Published September, 2001