Q: Mood Stabilizers & Dissociative Identity Disorder
Would u still use a mood stabiliser to treat extreme mood swings for someone who
has also got Dissociative Identity Disorder (Multiple Personality Disorder)?
I ask this because i have had the label BPD for 3 yrs now, i have also
previously been diagnosed as having psychotic depression or schizophrenia. I
have been on a few anti-psychotics - Olanzapine, risperidone, quetiapine and
aripriprazole. None of them worked/stopped the 'psychotic' behaviour. I have
also been on an anti depressant for quite a few yrs (firstly citalopram, then
escitalopram, sertraline and currently venlafaxine xl at 225mg).
I have extreme mood swings which my psychiatrist generally relates to BPD and
'leakage' from other alters (That is, feeling emotions that are not my own, they
are those from another personality).
In your personal opinion, would u say this is correct rather than giving a
diagnosis of Bipolar? Is it possible to have Bipolar and D.I.D? Would trying a
mood stabiliser be appropriate?
There is no bipolar in my family, although my mother and brother have mental
health problems. I do have a history of abuse as well.
Thank u for taking the time to read this
Dear Hannah --
First of all, let's take the
question of whether a mood stabilizer might be useful in someone with
dissociative identity disorder. That answer is clearly yes. We know this from
"clinical experience", which means that a lot of psychiatrists have used this
approach and found it to be useful, even though no one has done a specific
research study to test the idea. There are also several studies using mood
stabilizers and "borderline personality disorder", which has some similarities
to dissociative identity disorder (and therefore we might extrapolate a bit and
assume that these results are suggestive).
Of course I cannot tell whether you have dissociative identity disorder, or
bipolar disorder, or both, based on what you have written here. It certainly is
possible to have both, however. As you can gather, a mood stabilizer approach is
rational whether you have one, or the other, or both.
Indeed, the question that you have not asked is the one that interests me.
Consider this: antidepressants are known to make bipolar disorder worse in some
people, triggering manic side symptoms. Whether this occurs is not really
debated. It is still controversial as to how often this happens, but it is
clearly possible. As you mention, you have been on an antidepressant for quite a
In your case, as in the case of so many people whom I see in my psychiatry
practice, we have to ask if the antidepressants might have been in part
responsible for making the other medications you have already tried "not work".
I often tell patients that if they had a trial of lithium, or olanzapine, or
lamotrigine, and it "didn't work", but they are taking an antidepressant at the
time, they may have to repeat their trial of those medications later with no
antidepressant on board. They might get a different result.
So in my opinion, based on the information you present here, the more
interesting question about medication approaches in your situation is not so
much about mood stabilizers as it is about the role of the antidepressant. The
more your condition is truly "bipolar", the more one needs to wonder about
whether antidepressants could be getting in the way, even if -- especially when
you first start them -- they have been helpful to some degree as well.
May I emphasize, you could have dissociative identity disorder and do very
poorly if the antidepressant is gradually tapered off. You can also have bipolar
disorder, and still do very poorly if the antidepressant is gradually tapered
off. So whatever you do, discuss it thoroughly with your psychiatrist and if you
decide to tapered antidepressant, I would recommend that you do so very
gradually, taking at least four months to do so, which seems to increase the
likelihood of being able to get off them without worsening. Then, once off, it
takes several months to then see if things might be getting gradually better
just from having taken something out, as opposed to putting a new medication in.
In any case, I hope you find something that works well for you.