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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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