AboutIvan Goldberg, M.D. Expertise I am a psychiatrist/psychopharmacologist with many years of expereince in treating individuals with depressions, manic-depression (Bipolar Disorder), other mood disorders,. I am especially interested in the psychopharmacologic treatment of individuals with so called "treatment-resistant" syndromes.
Experience I have been on the staff of the National Institute of Mental Health, Columbia's College of Physicians and Surgeons, and the Columbia-Presbyterian Medical Center. I am currently in full-time private practice in New York City.
A.B. Johns Hopkins University M.D. N.Y.U. College of Medicine
I am the creator of Depression Central:http://www.psycom.net/depression.central.html
I am a 21-year-old female with a clinical history of depression. Recently I was reading a bit about bipolar disorder out of interest and I came across an article which talked about mixed states - either dysphoric mania or agitated depression. The thing which caught my eye is that when I read about the symptoms of agitated depression (racing thoughts, irritability, physical agitation, etc combined with depressive symptoms) it sounded uncannily like the symptoms that I have been experiencing. I will often have what I've been calling 'depression attacks' - I became quite openly hostile and irritable, and my thoughts start racing with a lot of negative ideas that I know are illogical yet find difficult to reign in. It kind of feels like how I imagine a panic attack must feel - physically I get a huge rush of adrenaline and become shaky/soaked in sweat. However, it's not quite the same feeling I have when I am 'anxious' per se - it's more anger. When this feeling wears off I am often left feeling very depressed (often at stuff I've said/done during this time as well) and tired - I'll pretty much revert to a more 'normal' depressed state or feel somewhat stable until it starts up again. I often have nervous tics, etc as well.
A bit of background - perhaps somewhat ironically, I was quite emotionally stable as a child/adolsecent, but when I was 17 and 18 I suffered (unknowingly at the time, the diagnosis was made retrospectively) from dysthymia. Over time this developed into full-blown depression, with the above symptoms and also the standard tearfulness, lethargy, messed up sleeping, etc. I tried prozac earlier this year for about six months but failed to see any effect. I've been on citalopram for about three weeks now and am waiting to see what happens there. I've also been seeing a therapist for a couple of months, which has helped with some issues.
Anyway, the question that comes out of all this is do you think it's possible I might be showing signs of a mixed episode? I took the Goldberg Bipolar Screening Scale test on this site and I got 27. I'd always dismissed the idea of being bipolar in the past, because I've never had mania so to speak and I'd always thought that bipolar was alternating between the two states. Additionally, even if it is just unipolar depression, do you think I might possibly benefit from some kind of mood stabiliser? My mood swings are affecting my personal relationships and it's a roller-coaster ride I would really like to get off.
If you could give me any insight I'd be extremely grateful.
Answer Hi Rosalyn . . .
The milder forms of bipolar disorder are regularly misdiagnosed as unipolar (major) depression. In the past few years it has become clearer that there are many people with what has become to be known as "soft bipolar" disorder or "the bipolar spectrum." You might Google those terms to learn more about how those conditions are described.
A family history of bipolar disorder or substance abuse would increase the possibility that you have some subtle form of bipolar disorder.
People diagnosed with subtle bipolar disorder generally do best with treated with a combination of medications such as lithium + lamotrigine. Conventional antidepressants can seem to provide some relief but often end up increasing the frequency and/or severity of the cycling process.
