Q: Can Depressive Triggers be Controlled with Medication?
I am a 39-year male with Bipolar II, rapid cycling, atypical symptoms, afflicted
since childhood, taking lithium and Nardil for nine years.
When I have deep depressions, they are always triggered by isolation, either by
leaving my group of friends or by breaking up with a significant other. When I
am first isolated, I don't feel any sense of loss or abandonment. It always
takes about 10 to 20 days alone, and then, by surprise, BAM! I rapidly slide
into depression and stay there for months. It is as though I cannot tell how
much the attention of others is propping up my moods until I or they leave.
Although I am a quite social person, I usually don't feel that emotionally close
to people--until I leave them that is.
Do you think the right medication could help conrol my depression reaction to
Can you postulate any biological mechanisms for such a "delayed" trigger?
Do you think extreme rejection sensitivity (which I have) is related to this?
This is no hypothetical matter. I need to find a job (I'm unemployed) and may
have to accept a position far from family and friends. I'm concerned about how
to make a potential transition without falling apart two weeks into the new job.
P.S. Thank you IMMENSELY for your Bipolar II website, Dr. Phelps, it is
Dear Mr. P' --
Glad you found the site helpful. Yours is an interesting question, though from a
painful situation, clearly. Could some medication forestall this? I cannot
answer from experience with my patients, and I've never seen this discussed in
the literature, so the best answer is "I don't know". To guess: sorry, the first
thought that came to mind was "maybe". But perhaps you could engineer something
like this, which would be a serious recommendation: if you were forced to move,
could you find a therapist in the new city, in advance, and actually start work
with her/him before the final move? I'm sure logistically this could be really
tough; perhaps more workable is to do your hunting in advance, by telephone
(here are some ideas on
finding a therapist, which you may have
seen); and arrange an appointment before your move, to meet, hopefully several
times, before the usual "BAM" time.
Mechanisms? You're right, it's definitely postulating. Well, we know stress
makes bipolar disorder worse, often precipitating the first episode and then
perhaps accelerating or roughening the course thereafter, and these events sound
like big stresses (obviously). I would agree with your guess that the "rejection
sensitivity", which you're aware is part of the "atypical" set of symptoms, is
likely part of this somehow. I wonder if a really rigorous cognitive-behavioral
therapy might be able to soften that blow some, in advance of the move, working
on the thoughts about the "meaning" of aloneness. (Here are some notes you may
also have seen about some
I'm particularly impressed with a new approach to cognitive therapy that
emphasizes a more Zen-like approach to thoughts; see Mindfulness-Based
Cognitive Therapy by Zindel Segal and colleagues, which although it's a
therapist's manual, basically, is still good, and you could even give it to your
therapist if you liked her/him otherwise and wanted him/her to try this method
with you (I have the perhaps naive hope that at least some therapists might be
open to that move). Segal's spin might soften the technique appropriately for
someone with rejection-proneness.
Smart to try to figure this out in advance. Good luck on that.
Published October, 2003