Expert: Ivan Goldberg, M.D. - 1/26/2011

Question
Hello doctor

I am 34, male, single. I was diagnosed as Cyclothymic last year. My mental problems started at young age, when I was 12. According to what I've learned from psychiatrists I have consulted, I experienced mixed symptoms all along this time. OCD symptoms mixed with melancholia, phases os pure depression with low self-esteem and difficult times to play a normal gender role (insecure and feeling weak as a man), periods of panic-attacks especially during treatment with SSRI. During the normal phases I am very creative and productive. I feel I am fairly gifted in many fields.

What can I expect from a mental health like this? I know it is far from being a serious illness like a bipolar disorder, but the fact is that I don't feel I am Psychollogical well fitted in many ways (interpersonal relationships) and I have had really hard times during the worst depression periods. So what can I expect from an ilness like this? (OB I have been on Sertraline 50mg and Seroquel 100mg rising to 200mg).

Answer
Hi . . .

It has been my experience that because of the danger of tardive dyskinesia, antipsychotic medications should, with few exceptions, only be prescribed for people with psychotic disorders. By definition, if you truly have Cyclothymia, you are not psychotic.

With the combination of psychotherapy and lithium most of the patients I have known with true cyclothymia do well both occupationally and with regard to their family and sexual roles.

Medication without psychotherapy is not an appropriate treatment for people with cyclothymia.

Best regards . . .

Ivan
%%%%%%%%%%%%%%%%%%%%%%%%%%%%%