Any Idea What is Happening to Me?
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Q:  Any Idea What is Happening to Me?

Dear Dr. Phelps

I am Ali, a 24yrs old male with GAD and OCD and Bipolar II(Rapid cycling and Mixed) from Pakistan, South Asia. With whatever little concentration i have, been trying to use to to read on your comprehensive site.

After 6 years of mal-treatment and taking almost every medication on the market, with my own effort, i was able to figure out and convince my doc that i had GAD along from OCD. Further Failing GAD treatments for 6 months, found out that also had bipolar 2 Spectrum disorder, thats why meds were worsening depression.

2 months back, thought had found the panacea with Dr. Nassir Ghaemi's article "Anxiety and Bipolar Disorder" and that the mood stabilizers would now finally cure all my problems.

Recent events / Complications
1.First the doc started with Olanzapine. Bad luck! It initially gave mild hypomanic symptoms, then as dose increased full blown dysphoric mania with rage, shouting, breaking stuff etc.

2. Then the same happened with Seroquel.

3.After the took Sodium Valproate for 3 weeks, dose up to 1800mg with no improvement whatsover.

4.Recently took lithium. It actually worsened my depression, sleeping 16-18hrs, crying continously, no therapeutic effect. while the cycling continues. Blood levels 0.88 (0.5 - 1.2).

I am quite crushed and hopeless with the consistent failures. Do you have any idea what is happening to me? Are there any treatment options left? what should i do that might help me?

I would be extremely grateful for your advice.

Best Regards


Dear A --
Sorry to hear that you have taught yourself so much and then have not seen some direct benefits from doing so, only disappointments.  In medical school I was taught that "when your treatments don't work, re-think the diagnosis". So with the outcomes you have been getting, theoretically the first thing to do is go back and wonder again about what is wrong here.

For example, what else looks like bipolar disorder but actually isn't (and includes a significant degree of what looks like anxiety)? one such candidate would be "borderline personality disorder".*  This used to be a very bad diagnosis.  But now there are multiple specialized psychotherapies with very good evidence for benefit.  I'm not sure you would be able to find one of those psychotherapies, as such, and Pakistan.  But I'll bet, with the evidence you have displayed here being able to teach yourself things, that you would be able to do something with those methods, if that diagnostic perspective was more on target than "bipolar disorder".

Of course, up until very recently, figuring out an accurate diagnosis was the role of a good psychiatrist or a psychotherapist -- not the patient him more herself. Nevertheless, learning more I think should almost always be a good thing.  It does carry the risk of raising hopes that can then be crushed.  I am sorry that you have had that experience. I hope that the next treatment options which emerge from the combination of your own efforts to learn and understand, and a good clinician, get you much better results.  Good luck with that.

*(of course I certainly do not mean to imply that I think this is your diagnosis.  I merely pose it as an example, and one that you will need to think about as you consider other such possibilities, such as a really unusual version of some anxiety disorder)

Dr. Phelps

Published May, 2009


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