Feels Their SO Has Been Misdiagnosed
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Q:  Feels Their SO Has Been Misdiagnosed

Dear Dr. Plyler,
    My significant other has been (in my opinion) misdiagnosed with A Typical  depression and Dysthimia. He seems to be out of most psychiatrist's scope. He tells me he had symptoms of highs and lows and just feeling different from a young age that he managed to hide, along with anxiety and concentration problems, but at the age of around 25 he  became foggy, disinterested and purely motivation less and flat. He finally realized there was something wrong, so when he first entered the mental health world, they immediately told him he has depression and tried him on an anti-depressant. He had a seizure from it. They continuously tried and endless amount of anti-depressants which all ended up giving him a paradoxical reaction. At this point he also realized his high sensitivity to medication. He tried everything from exercise to acupuncture. At the hospital of Pittsburgh they put him on Lamictal which initially had positive effects until they doubled the dosage and he got the deadly rash and barely escaped death. From then on he has taken mindfulness and DBT courses. Nothing. They finally put him on Nardil which was absolutely the most  detrimental thingthat could have been done, no sleep, no appetite, lucky to get out of bed... for three months. Last resort became ECT, he did a full course and  nothing stuck. I am convinced that there is an underlying disorder which is causing these depressive symptoms, I'm convinced it he is somewhere on the Bi-Polar  spectrum, it's been established that he does not have a personality disorder, he is  fighting and pushing to find something that works but these 3 years of trial and error efforts need to be discontinued. They will cause him to swing moods like I've never seen and have basically every other negative effect, mania, deeper depression, even after weeks and weeks of trying to let what where initially thought as "side effects" nothing positive ensued. And if it did, it would work well for a few days to a week   and go downhill from there. There is the option of trying Lithium but that is very very very risky considering his sensitivity to psychiatric medications. I'm desperately researching other possibilities as he is at his wits end with it all. I was curious to know your thoughts on his diagnosis... any advice would be greatly appreciated. I strongly believe that there is always a solution out there, no one is hopeless. Thank you so much.


Your significant other has certainly suffered a great deal and has tried a large variety of medications and therapies with little effect.  I agree that bipolar disorder must be considered when the normal treatments for unipolar depression have failed.  Also we must consider the possibility of comorbid disorders such as anxiety or attention deficit problems that may be contributing to his lack of improvement.  I agree that trying Lithium has some risk but I think it would be the best medication to try at this point.  He would need to start at the lowest possible dosage and go very slowly with titrating upward to decrease the risk of side effects.  Your letter wasn't clear about the antipsychotics but they are also a good alternative.  Zyprexa, Abilify, and Seroquel have all showed benefit in mood stabilization and treatment resistant depression.  The last, and possibly most important, piece will be finding a psychiatrist that can manage the scope of his illness. 

Dr. Plyler

Published November, 2011

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