Expert: Jennifer - 11/18/2009

Question
Hello, I need to give you my profile firts. Sorry but I am not a native english speaker and I find myself a little restless at this moment, so I may find it difficult to express...
I have had bouts of depression/anxiety through the years. I am 33 but it all started when I was 12. Those episodes were not rarely triggered by interpersonal issues. From time to time I would feel an excess of affection toward some of my friends who I would idealize (generally someone I would feel like to be a father to me - my biological father has not developed a bond with me, although we've always lived together. But he has been diagnosed as a personality disorder sufferer and, in fact, he fails to show (and probably) feeling deep emotions as a normal father would).
What bothers me is that those feelings develop until it become a real obsession. It's impossible to describe how deeply upset and sad it makes me feel. It generally degenarates to a depression episode. Even today I feel too attached to some of my friends - to the point that it hurts.
I haven't told it to the psychiatrist because he doesn't seem sympathetic enough. But it is a real issue in my life - i have tried psycotherapy but it didn't work. I still don't know how to deal with it. My psychiatrist diagnosed me as no-specified personality disorde and cyclothimical. In my "repertoire" I have had panic attacks and OCD-like symptoms. I am a creative guy and have always been the best at school when younger.
I am nowadays on sertraline 100mg and clonazepam 05 drops (I can't do without anxiolithic or else I get too restless at night with thoughts and psychomotor unease). But I am not convinced that I am cyclothimical. I also take a hypnotic med called Stillnox (here in Brazil) to sleep since I tend to sleep after 02 o'clock and wake up midday if left by my own. I have had repetitive songs playing in my mind. I know that it is normal, but in my case it's been to long and it lingers to such an extent to the point that it seems to me normal to live this way. I often feel my thoughts agitated at night, as though I can't deal with the strong feelings that arise from them. When it gets overwhelming it can make me feel confused and I start to panic or I wake up jumping from bed over and over, with a pounding heart. For those reasons I take clonazepam at night to stop the wave of agitation and, after a few minutes, I feel alleviated and at ease.
I have been consulting a clinic who doesn't know details of my mood issues but he prescribes me sertraline. Would it be a good idea to suggest him to prescribe me valproate? My former psychiatris once told me that it could help me free from clonazepam and that it would end the irritation I was feeling at that time. Could sertraline alone be the cause of discomfort? Is there something that could be called "over-affectiveness"? - it is important for me to know because I am overweighted with it and I can't cope with it anymore. Would it be a symptom of an illness? Could valproate help me set things down? During the morning I am overly sleepy. After that I become very active at work. At night I do work out. And only after that those feelings become evident. Is it atypical?

Please help me because no one outside this forum has helped me understand those odd moods.

Bruno

Answer
From what you've written about your situation, I've noticed that the major theme throughout is that you've gone to several different sources in your area's medical community seeking assistance but (if I've read it correctly) you have not given any of them your complete information/background.  Is there a reason why you wouldn't be comfortable with disclosing fully your medication history/present prescriptions as well as the problems and concerns you have mentioned to me here?  Because even medical professionals are reluctant to give their opinion on the possible issues anyone may be dealing with, I cannot provide any statements regarding your situation and any specific conditions or medications that should be directed to the attention of a mental health specialist in your area who will be able to properly determine what the diagnosis and treatment should involve.

I will recommend something for you to consider before you go in for an appointment with a new health care provider; because it is important to know everything a patient has been prescribed, past and present issues and symptoms, and why they've come in for the appointment as well - if the doctor is going to be able to make the best decisions about what treatments you could benefit from, etc...they need to know everything there is about your situation and your previous treatments.  A new doctor is essentially an opportunity for you to really be honest and fully open regardless of what previous doctors might have felt about anything you've said to them.  Take that opportunity and give total honesty, and you'll achieve a better outcome in the end as well as increase your awareness and involvement in your own treatment process.  I hope that you'll choose the best course of action, and please feel free to ask me anything further or to provide clarification if needed.  Good luck, let me know how things turn out for you.