Expert: Joyce A. Anthony - 10/9/2009

Question
QUESTION: My doc diagnosed me as cyclothimic. After I described my symptons along twenty years, he agreed that I did suffered from episodes of major depression. When I confronted him with the question that it sounded more like a diagnose of bipolar II, he answered that my phases of disthimia evolved to more severe episodes of depression. He called it double depression (disthimia and major depression), and explained that I would have TWO diagnoses at the same time.
I felt it very hard to accept, because in face of this, the differential diagnose between bipolar II and cyclothymia doen't make any sense anymore.
How can I understand it? Does it raise a suspect that I might be bipolar II?
Besides this I have had hard times trying to sleep recently. I have virtually shift from night to day in my sleep habit, which is disturbing my life a lot. Could this have anything to do with cyclothymia or bipolar II?

ANSWER: Hello Bruno:

While both Bipolar II and Cyclothymia are similar, they have one main difference.  In cyclothymia, there is a absence of any mania at all.  Your doctor most likely came to this diagnosis after reviewing your history.  I would not worry about being Bipolar II unless you have a period of mania-like symptoms.  

Very often, people will have two or more diagnosis.  The dysthymia would be an almost constant low mood, while the major depression would account for severe episodes of depression.  I hope that helps make it a bit clearer?

         Joyce A. Anthony

---------- FOLLOW-UP ----------

QUESTION: I agree that mine is a strange case. I have already undergone periods of great and sudden suffering with depression. Once I needed to stay 90 days away from work.

In fact I can't do without antidepressants or I surely get depressed and the severity is unpredictable, although it is more probable that I will go mildly depressed.

I have been on clonazepan for years. If I stop I become vulnerable to pre-panic attacks (I stop its evolution taking clonazepan). I get restless and my sleep is interrupted with a sudden and strong jolt time after time. It usually makes me felt deeply disturbed and disoriented. So clonazepan is something I keep close to my bed. One psychiatrist who I consulted for five years told me I may never interrupt my treatment with clonazepan because of those persistent symptoms.

Is there anything wrong with taking antidepressants and clonazepan in a non-stop, lifelong basis with a symptomatic backdrop like mine?

Answer
Bruno:

This still sounds like your doctor is accurate about his diagnosis.  As for the medication, there is no problem taking both medications throughout your life--providing the doctor prescribes both!  You should never take medications together that your doctor has not been made aware of and agreed to.  Talk to your current doctor about the clonazepan and see what he/she says.  

         Joyce A. Anthony