Expert: Ivan Goldberg, M.D. - 3/12/2011

Question
Hello, I am a 21 year old college student, for the past three years I have been suffering from a mental illness that me and my psychiatrist still can't figure out how to treat.

It started out with anorexia/bulimia at 17 and low level depression, after I turned 18 and graduated from high school I severely starved for three months accompanied by caffeine abuse, which may have caused the start of racing negative thoughts which insult and offend me. These are not hallucinations as I was aware they were just thoughts and just lasted two weeks, however my psychiatrist diagnosed it as major depression with psychotic features and put me on Geodon and Celexa, which didn't help much and made me sleep the whole day. After I turned 19, the negativity of the thoughts stopped but they were still racing and I became extremely preoccupied  with looking good and getting attention all the time, which bothered me at the same time. My doctor then considered it could be bipolar disorder and tried Lamictal, which agitated me even more for some reason. I am terrified of trying antipsychotics or certain antidepressants because of the weight gain, as Seroquel helped me sleep but I became more depressed when I gained twenty pounds. I have never hallucinated, and the racing thoughts I experience sound like a bunch of unrelated sentences together: ("french toast....top of the morning...the president at wednesday...etc...)

Some background on me: I have had a relatively happy life, stable and supportive family and friends and excelled academically. My maternal uncle tells me he experienced these things(nonsensical racing thoughts, severe depression..etc.) when he was my age too but they eventually went away. He is 45 now and if he didn't tell me he experienced this I would have never guessed as he is very calm and even tempered now.

My doctor agrees that I have anxiety, a bit of compulsive behavior and body image issues, but I want to be sure it is not going to develop into something worse like schizophrenia as I know some of the symptoms are agitation and disorganized thinking. I would really appreciate if you could give me an opinion on what I could try and if my case sounds similar to one of a bipolar disorder.

Answer
Hi Danielle . . .

It certainly seems as if you have a complex situation with which to deal. It is impossible to make a diagnosis via the internet but there certainly is a possibility that you have a disorder in the bipolar spectrum (You might Google that phrase and read about it).

I a a strong believer that antipsychotic medications such as Seroquel should be almost exclusively be reserved for people with obvious psychotic symptoms. They should not be used to deal with non-psychotic syndromes.

It sounds as if what you most need is NOT a suggestion for what drug should be tried next, but a clear cut diagnosis. With a firm diagnosis, a program of psychotherapy and Psychopharmacologic treatment can be planned.

I suggest that you have a diagnostic consultation with one of the experts listed at:
http://www.psycom.net/depression.central.psychiatrists.html Following such a diagnostic consultation the matter of treatment can be addressed.

Best regards . . .

Ivan
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