Expert: Ivan Goldberg, M.D. - 7/29/2007

Question
My 19 year old daughter came home from college this summer with a change in her personality.  She had underlying depression and severe anger which she was able to hide from co-workers and others.  When we had her see a counselor to try to help her, she was put on St. John's Wort which caused the anger to increase with irrational thinking.  After stopping the St. John's Wort, she went back to her more subtle depression and irritability.  We then had her see a psychiatric nurse practitioner who put her on Lamactil for Bipolar Type II.  After four days, her anger and irrational behavior increased and she began to talk of suicide.  Within 24 hours of stopping the Lamactil, she was back to the more subtle depression, but has begun to have sudden changes in mood to laughing and happiness and then back to anger and depression within 24 hours.  She has been irrational, but has never lost total touch with reality.  We are in the process of trying to locate another psychiatrist, but in my research this all seems pretty atypical.  Any suggestions?

Answer
Hi, Carol . . .

It is impossible to make a diagnosis on the basis of the information your provide. But, it seems highly likely that your daughter has a disorder in the bipolar spectrum. Any substance with antidepressant activity, including St. John's wort, and Lamictal can induce mania, hypomania, or rapid cycling. Often Lamictal has to be combined with lithium or another mood stabilizer for optimal mood control.

A list of psychiatrists with more than average skill in diagnosing and treating people with mood disorders may be found at:
http://www.psycom.net/depression.central.psychiatrists.html

Best regards . . .
Ivan