Thoughts on My Dx & Treatment?
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Q:  Thoughts on My Dx & Treatment?

Dear Dr. Phelps,
I am 49. I have just recently been diagnosed as Bipolar by a new psychiatrist, after years of being treated for years for depression. I was described as chronically depressed with exacerbations into severe depression without psychosis.  I also have fairly severe OCD. I was treated with several SSRI, the most tolerable being Zoloft and most often the drug Wellbutrin. The Wellbutrin had the only really tolerable side effects - was only marginally effective, but did significantly kicked up my sex drive. The Zoloft at 100 - 150 mg. made me fatigued and significantly affected my very short term memory and mental acuity. I'm a writer/poet and this side effect was intolerable after a while. I was also diagnosed with borderline personality and avoidant personality. I find it almost impossible to leave my house now, meet new people, or get involved in a new career. I have in the past been very successful in a career, am very well liked by people when I am forced by my husband to socialize. My interpersonal skills are extremely good, and I have a great sense of humour when feeling well. I am very sensitive, emotionally intense, very sensitive to rejection and have pervasive low self-esteem. I have periods of  irritability, overspending, agitation, inability to sit still, and much chronic inability to concentrate. I do not self-harm, threaten or attempt suicide, even though I have expressed "passive ideation" on a frequent basis. I will probably live to a ripe old age, I don't feel I'm really likely to do it. When I'm not feeling really lousy, I have many creative interests that I become immersed in. Tho'not of late.
I am currently, via my new doctor, being worked up to 200 mg. of Lamictal. So far, I am still in a moderate state of depression. How likely is it that the Lamictal will be helpful for my depression, which seems to be my main, chronic problem? Or solve my other problems? I generally feel that I am spiraling downward. Life seems more and more difficult - my social anxiety makes me almost agoraphobic!
My recent Rorschach test (sorry I took it) described much depression, borderline and avoidant personality, very high intelligence and creativity. I also got a "hit" on the schizophrenia scale, which makes me feel loony tunes. My doctor discounted it, I have never been hospitalized, my cognition is intact, have never had any hallucinations, don't hear voices. I've read that many creative people can score on this scale. I am sort of desperate to solve this misery and my inability to function for some time now. Is the lamical going to be the answer? Does this sound like just bipolar? Do you suggest any other medication that won't effect my thinking, creativity, won't make me fatigued. I much prefer slightly stimulating medications, I have a general problem with fatigue. My thyroid tests are perfect, lowish TSH. Doc doesn't want to try thyroid.
Anyway, any thoughts on medication and what my diagnosis and treatment should be? I had much potential and lately spend all my time worrying, cleaning the house and doing laundry and excercising excessively.
That's my life. I've been told my IQ is higher than 98% of the population, and I'm going nowhere. These DSM diagnoses are very pathologizing and make me feel worse. However I can accept such a diagnosis if it will help steer me toward better treatment, which seems to evade me.

Thank you for your thoughts.

Dear Ms. B' -- 
A thought on "
bipolar versus borderline"; and yes, there's a very good chance lamotrigine or something like it would help.  The Treatment section of my website on bipolar II might be worth checking out. 

Dr. Phelps

   Published June, 2002


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