Delusion or Psychotic Episode
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Q:  Delusion or Psychotic Episode

I was sitting in a one on one session with my therapist, whom I have been working with for over two years now and trust almost more than anyone, and suddenly I looked up at her looking at me and she looked completely evil to me, like she was about to "attack" or "get" me or something.  I knew this was not true but this delusion or whatever it's called scared the shit (excuse my french) out of me.  My question is just that,  what was this little episode, was it considered a delusion, a small psychotic episode? It was really really scary.  My fight or flight respnses were totally on and I had to use all my will to stay there sitting across from her.  Please tell me what you think.  I am on the following meds just for your info: 10mg zyprexa, 375mg depakote, 10mg lexapro which I just started yesterday.  Thanks!

Dear Ms. L' -- 
First, here's Dr. Jamison's very worthy description of the symptoms of bipolar disorder, which I think might capture this little experience (italics mine for emphasis re: your experience): 

"The clinical reality of manic-depressive illness is far more lethal and infinitely more complex than the current psychiatric nomenclature, bipolar disorder, would suggest. Cycles of fluctuating moods and energy levels serve as a background to constantly changing thoughts, behaviors, and feelings. The illness encompasses the extremes of human experience. Thinking can range from florid psychosis, or "madness," to patterns of unusually clear, fast and creative associations, to retardation so profound that no meaningful mental activity can occur. Behavior can be frenzied, expansive, bizarre, and seductive, or it can be seclusive, sluggish, and dangerously suicidal. Moods may swing erratically between euphoria and despair or irritability and desperation. The rapid oscillations and combinations of such extremes result in an intricately textured clinical picture." (Kay Jamison, Ph.D.)

But just in case the timing explains something:  if you wrote this the day of that experience, and thus started the new antidepressant just the day before, then you should call your doctor and report this experience.  In my opinion it could be very likely, if that was the timing, that you had some "manic side" symptoms being precipitated by the antidepressant, and they could easily recur (in fact I'd expect you'd have had some more by the time you read this).  

But if the timing is the other way around (episode first, then added the antidepressant), I'd worry less about the exacerbation-by-antidepressant part (less, though not zero).  

Dr. Phelps

Published November, 2002


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