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Q:  I was DXed with severe depression 7 months ago and i have been on effexor xr (max) and klonopin for severe panic disorder. My doctor always asked me if I had major mood swings. Almost as if he saw some of the tendencies of bipolar. I just got married to my husband 1 month ago which i have 3 kids with and have been with for 8 yrs. I have done alot on impulse (main thing being engaging in sexual activites with other males) not thinking  of what will happen. But I still know in my heart I love him. I have  asked for a divorce 3 times for I get extremely annoyed with him but deep inside again I know I love him with all of my heart. I feel crazy. The meds I am on are not working and I was wondering if I should tell these things to my psychiatrist?

 Thank you,

Dear L,

     Hidden in the phrasing of your comments and question seems to be the
answer to your own "dilemma".  Let's say you have a mechanic who is
attempting to fix your car for the past 7 months.  His repairs haven't worked but he seems to have other ideas about what might be wrong based on questions he's been asking you.  You continue to pay your mechanic for the repairs that do not work.  Even though you claim to want it fixed and YOU are not a mechanic, you decide that certain information about your car is not important enough to mention.  Your frustration about your car problems continue and to date, it is not working properly.  The answer to you question is a question.  Do you want your car fixed or not?  If you do, your mechanic absolutely needs ALL possible information you can provide him in order to make an accurate diagnosis in an attempt to get you "up and running", don't you think?

     For many afflicted with bipolar disorder, it can take from 7 to 10 years to get a correct diagnosis.  Most individuals are first diagnosed with depression because their depressive symptoms are unpleasant and they are more likely to seek relief for them.  But when they are in a manic phase, they often feel ecstatic, make unwise decisions, engage in dangerous activities (e.g., sexual indiscretion), and have unrealistic views of what is possible.  You likely would not see yourself as ill or view your reckless behavior as problematic.  However, medications for treating depression, e.g., effexor xr, etc. are not good for treating mania, so more problems can  ensue with an incorrect diagnosis.

     In order to assist your recovery if you have bipolar behaviors, be relentless in getting the correct diagnosis.  Communicate openly about ALL of your behaviors and symptoms and allow your "mechanic"/psychiatrist to get as much accurate information from you as possible for your sake, your partner's and your children's.  Have patience and persistence to get the correct medications and dosages.  Once you feel better, you need to continue you medication for the rest of your life.  Stay on your treatment.

     Trust yourself to be the honest person you are.  Go with your instincts as you have in this email.  You are paying for a service and you deserve the best you can get by contributing to your own treatment to the best of your ability.  Of course you should talk to your psychiatrist about all your concerns  if you want to be helped.

David Schafer, M.Ed.
Staff Psychologist

Published April, 2006

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