Are These "Voices" I'm Hearing?
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Q:  Are These "Voices" I'm Hearing?

Though presenting symptoms of Bp disorder since pre/early teens, I was only diagnosed Bp 3 years ago.  Previous treatnment from family physcian included anti-depressants, sleeping pills, and anti-psychotics.  I am concerned about having treatment resistant BP and about compulsive, uncontrollable thoughts to hurt/kill myself.  I trust no one and fear being commited.  As for the "hearing voices"...can you explain this to me?  I always thought this to mean a different and distinquishable "voice" inside or outside of a person's mind "instructing" a person to behave or involve themselves in detremental self harm or harm of others.  However, recent readings have lead me to question that the compulsive thoughts I have to cut off my hand, cut my body, burn my body, kill myself are "voices" that many professionals have inquired, "Do you here voices" to which my reply is "No".  Can you clarify for me what it means to "hear voices" and what can I do to stop this maddening phenomena?  I am currently taking zoloft 150mg, clonapin, 1mg, and lithium 600-900mg (I do not tolerate the lithium very well), and also remeron 30 mg to help me sleep.  I find I quickly become acclimated to a medication and they have to be increased to continue to be affective.  Then come the physical side affects of nausea, disorientation, etc.  Also, I have had episodes in which I believed myself to be the ultimate "power" of the universe and episodes of paranoa in which I believed my wife and mother to be conspiring to have me committed.  I realize there are alot of questions here....has my Bp diagnosis been I suffer from other mental disorders.  I have equal episodes of wanting to destroy the entire world as humanity is the lowest form of life on this earth.  Please help if you can.  I am so lost and am not able to accurately describe these things to my wife or therapist...neither of which has proven to be trustworthy.  I am afraid my only relief or peace will come from death. 

Dear Bud -- 
Of the several important questions here, I'll pick a couple I think are the most likely to lead you somewhere good (I hope).  

First, are these "voices" you're hearing?  It won't matter too much, as far as guiding treatment, in my view -- that is, I would not make them the focus except to watch how much risk you might face of following "their" instructions -- which could be substantial and I hope your doc' is aware of them; if not, inform her/him.  If you can pretty clearly state you're not planning on following through on those "voices" or thoughts, you're just having them, then she/he will not be able to "commit" you (although one could argue that if she sees/hears something in your report that does allow her to do so, you'd be best off if she did, and that you (and me, sort of) shouldn't be second-guessing her on that...).  You've got serious symptoms, but fortunately they are treatable in the vast majority of people, so you shouldn't hold back too much now on trying to get them taken care of. 

Second, about halfway through the paragraph I started thinking a common thought for me as I read stories like this:  "I hope he's on an antidepressant".  Because, for one thing, it's so often the case.  And for another, is there something that might be done to radically change the course of things here without necessitating the really complex mixing of mood stabilizers that can (here's an answer to one of those questions) often help someone like you.  In other words, there's the good option of combining mood stabilizers, for the symptoms you describe.  But first there's the option of -- slowly, and with your doctor's awareness, consent, and guidance -- having a look at things without an antidepressant on board.  This is a very standard recommendation from many mood experts:  to treat complex mixed states and rapid cycling, first try not using (which usually means "stopping") an antidepressant (but, slowly taper, and not on your own, ok?)

Has your diagnosis been accurate?  There's nothing in your letter to suggest otherwise.  Get some help soon, it's very likely to make your life better.  Good luck, and I hope that's what happens soon. 

Dr. Phelps

Published June, 2003


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