Having Trouble Being Diagnosed
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Q. Having Trouble Being Diagnosed

I am having trouble being diagnosed. I have seen two pdocs and so far the ideas from the first are BPII with GAD and OCD. The other pdoc started with agitated depression, then hastily changed her mind as I went suicidal after she removed the Klonopin from my meds.  Now we are on to BPD, Cyclothermic Disorder with Double Depression and I am nothing but confused.

I take Klonopin, Elavil and Lamictal. It has been the Lamictal that has turned my life around.  In the last two years I have had one Hypomanic phase, two Major Depressive Episodes and one mixed state that lasted 2 weeks, with one suicidal thought but never self harm.

Please can you help my confusion and give me some idea where we should be looking.


Dear Ms. H' -- 
I would have to defer to doc's who've actually talked with you, but as you may have gathered from my website's discussion of
GAD "versus" BPII, there's so much overlap there that I don't think it's really possible to distinguish them in some cases.  What matters at your stage is treatment options, of course.  With the bipolar perspective comes the notion of trying to avoid antidepressants so as to decrease rapid cycling.  Usually folks like you who come into my practice have had 3 or more antidepressants already (often many more than that), so there's no much point in thinking about antidepressant-based approaches by that time.  Sounds like Lamictal did something solid and good, so I'd ask your doc' about trying to slowly taper out the Elavil, perhaps replacing it with a low dose mood stabilizer (as I imagine it's in there for sleep, and you'd want something else to help you sleep: lithium, Depakote, or Trileptal would come to mind; as you've probably learned, adding the Depakote to your Lamictal must be done with great caution as they increase each others' levels in most folks, substantially in many people).  

I think much of the material on my site under "diagnosis details" would be relevant to review.  Good luck to you. 

Dr. Phelps

Published February, 2002



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