Expert: Ivan Goldberg, M.D. - 10/5/2011

Question
Doctor Goldberg

My Psychiatrist treat me with Seroquel, an antidepressant and a anxiolityc. I have already taken lithium but it didn't seem to work. My Doc says my main symptom is irritation. On the other side depression has been controlled for years.

I am on my 35's, but when I was a teenager OCD-like symptoms almost destructed my life. It had profound religious roots such as an uncontrollable pattern of thinking of "offence to God". I felt profoundly disturbed and usually got very depressed because of it to the point of losing hope in life. After an episode of "forbidden thought" I'd usually spend  up to a whole week in a "mental trial". There would be two sides in my midn - one trying to defend me from my own accusations and the other who accused myself to be inherently bad and not deserving any kind of good. it was a profound mental suffering and I had no control of it.

There were times when I could not control my mind from thinking that i had touched something contaminated and that I was dying from a infectious disease. I have a cousin diagnosed with a serious bipolar disorder. To my surprise he has symptoms similar to those. He got to the point of public scandal in the street he lives exposing himsel to ridicule and trying to eat poisonous plants when he had a strong episode. All of this out of "religious" thinking - he thought at that time he nedded to commit to crazy acts motivated by an obsession that flooded his mind: the need to prove himself he was "pious" enough to God.

Is there any link between OCD and Bipolar, a kind of strange mixed state disguised as OCD?

Thanks a lot

Answer
Hi, Bruno . . .

There is a connection between OCD and bipolar disorder. It is quite common for people diagnosed with bipolar disorder to have shown more obsessive and compulsive symptoms than people without bipolar disorder.

The antidepressants clomipramine and fluvoxamine have anti-OCD activity. In people with bipolar disorder I usually prescribe lithium along with these medications. The lithium has two purposes 1) to make the clomipramine ore fluvoxamine work better, and 2) to protect the individual from becoming manic from those medications.

Best regards . . .

Ivan
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