Expert: Libby Bonner - 10/6/2009

Question
QUESTION: I was diagnosed as cyclothymic one year ago. As I read the definition, I found one inconsistency in the diagnose. I have already had more severe episodes of depression. Is it compatible with the definition of mild depression linked to cyclothymia? If so, It is not different from bipolar II, right?

If the severity of episodes of depression is a key to differentiate Bipolar II from cyclothymia, how can I be diagnosed as cyclothymic? Should I consult a second opinion?

ANSWER: You could explain to your current doc that your episodes of depression seem more frequent and/or more intense than in cyclothymia, or you could get another opinion.

It's not unusual for illness characteristics to become clearer to patients once they are diagnosed nor for docs to pick up on more nuances with repeated appts.  But if you feel that the diagnosing doc disregarded a clear history that would have suggested Bipolar II, you might be more comfortable going forward w/someone else.

Give some thought to how well appt/s have gone, your intitial and current feeling about the doc, how attentive s/he was to your remarks.  If you think this pt-doc relationship has a poor portential, weigh that in your decision to get a 2d opinion.

For more info, see www.mentalhealth.com

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

QUESTION: In addition to the followw up I sent hours ago, I almosto forgot to say that I have had remarkable sleep problems. I always tended to sleep late and wake up late. I would usually sleep at two in the morning and in the morning I'd barely could get off bed to go to work. But things got even worse over the last seven days. I have no more been able to fall asleep before dawn! It's been six days that I fall asleep at five in the morning and wake up in the afternoon. I simply haven't been able to avoid it. In my locality the sun is rising at five in the morning, since here is in southern hemisphere. So I can see the sun rising and hear the birds singing in the beggining of the morning but this very disturbing to realize that I lost another night of sleep.

I think this information may add some relevance to what I have written before.

thanks

Bruno Lima Lobo

Answer
Bruno, I don't know.  And I didn't know about the deep depressions nor the Sertraline.
You sound a little bit in crisis....maybe you should try to see your doctor sooner than your next scheduled appointment.

You do a appear to have chronic Something, or Somethings.

regular structured contacts with other patients, or regular visits with social workers.  They are not dependent on meds only.  If you could add any of those kinds of services/activities to your life, they could be very helpful.

And yours seems a complicated case.  Having a second person look at your history wouldn't hurt.  But definitely find out if there isn't more than just medicine available to you.  Look, even, for some good online sites, where patients can chat w/ other patients. Or perhaps get recommendations for books to help you work on aspects of your illness/illnesses.

Good luck.