Q: Thoughts on My Dx & Treatment?
Dear Dr. Phelps,
I am 49. I have just recently been diagnosed as Bipolar by a new psychiatrist,
years of being treated for years for depression. I was described as chronically
depressed with exacerbations into severe depression without psychosis. I
also have fairly severe OCD. I was treated with several SSRI, the most tolerable
being Zoloft and most often the drug Wellbutrin. The Wellbutrin had the only
really tolerable side effects - was only marginally effective, but did
significantly kicked up my sex drive. The Zoloft at 100 - 150 mg. made me
fatigued and significantly affected my very short term memory and mental acuity.
I'm a writer/poet and this side effect was intolerable after a while. I was also
diagnosed with borderline personality and avoidant personality. I find it almost
impossible to leave my house now, meet new people, or get involved in a new
career. I have in the past been very successful in a career, am very well liked
by people when I am forced by my husband to socialize. My interpersonal skills
are extremely good, and I have a great sense of humour when feeling well. I am
very sensitive, emotionally intense, very sensitive to rejection and have
pervasive low self-esteem. I have periods of irritability, overspending,
agitation, inability to sit still, and much chronic inability to concentrate. I
do not self-harm, threaten or attempt suicide, even though I have expressed
"passive ideation" on a frequent basis. I will probably live to a ripe old age,
I don't feel I'm really likely to do it. When I'm not feeling really lousy, I
have many creative interests that I become immersed in. Tho'not of late.
I am currently, via my new doctor, being worked up to 200 mg. of Lamictal. So
far, I am still in a moderate state of depression. How likely is it that the
Lamictal will be helpful for my depression, which seems to be my main, chronic
problem? Or solve my other problems? I generally feel that I am spiraling
downward. Life seems more and more difficult - my social anxiety makes me almost
My recent Rorschach test (sorry I took it) described much depression, borderline
and avoidant personality, very high intelligence and creativity. I also got a
"hit" on the schizophrenia scale, which makes me feel loony tunes. My doctor
discounted it, I have never been hospitalized, my cognition is intact, have
never had any hallucinations, don't hear voices. I've read that many creative
people can score on this scale. I am sort of desperate to solve this misery and
my inability to function for some time now. Is the lamical going to be the
answer? Does this sound like just bipolar? Do you suggest any other medication
that won't effect my thinking, creativity, won't make me fatigued. I much prefer
slightly stimulating medications, I have a general problem with fatigue. My
thyroid tests are perfect, lowish TSH. Doc doesn't want to try thyroid.
Anyway, any thoughts on medication and what my diagnosis and treatment should
be? I had much potential and lately spend all my time worrying, cleaning the
house and doing laundry and excercising excessively.
That's my life. I've been told my IQ is higher than 98% of the population, and
I'm going nowhere. These DSM diagnoses are very pathologizing and make me feel
worse. However I can accept such a diagnosis if it will help steer me toward
better treatment, which seems to evade me.
Thank you for your thoughts.
Dear Ms. B' --
A thought on "bipolar
versus borderline"; and yes, there's a very good chance lamotrigine or
something like it would help. The Treatment section of my website on
II might be worth checking out.
Published June, 2002