Hi Cody! I believe I can be of help with this issue.
First, let me say I can imagine how scary and worrisome this situation is for you. So let's see if I can give you some clarity on what MAY be going on and how to get help. I am not trying to make a diagnosis here. I want you to understand that you have to go to your doctor and describe your symptoms and ask to be referred to a psychiatrist for a thorough psychiatric evaluation. In fact, I very much want you to print out my answer to you and use it to discuss this referral that is more than just important with your parents and your doctor. I believe the most likely disorder that needs to be considered is Bipolar Disorder (BD) with psychotic features. BD becomes most easily recognizable in late adolescence.
If this becomes your diagnosis, Cody, you need to know that not only have the medications available today become more refined, and not only has research into how to apply medications become much more complete, but the research into therapy to learn to MANAGE the disorder is so much more thorough. And research shows that treating BD with both meds and therapy is much more effective than either one alone.
I always go over the DSM-IV criteria with parents to make sure they're comfortable with what the psychiatrists have decided and that they don't want second opinions. So, let's see what the DSM-IV says and you decide. Here are the criteria for BD. Here's a layman's version that doesn't differentiate between Bipolar 1 and Bipolar 2. Because it's a non-technical version, it is not going to list all the different possibilities of BD, such as BD with psychotic features and suicidality. What I want you to look at is to see if the pattern of how you've found yourself living with mood swings and irritation, etc. fit. Okay here it is and then I'll be back:
Bipolar Disorder means more than wild mood swings. It doesn't necessarily describe someone who is "hot" one day and "cold" the next. Psychiatrists and other mental health professionals have it classified as an actual disorder in the Diagnostic and Statistical Manual for Mental Disorders IV, or DSM-IV TR. By understanding the technical aspects of Bipolar Disorder, one may be able to recognize the signs and symptoms of something other than a fickle mood.
- The DSM-IV TR characterizes Bipolar Disorder as a condition in which the patient has significant mood changes that last from weeks to months at a time. Patients will experience at least one manic episode where the mood is an elevated one; followed by a period of normalcy or balance for at least two months before an onset of a major depressive episode. These mood changes cannot be due to schizophrenia, schizoaffective disorder, psychotic disorder or delusion disorder. The mood changes also cannot be a direct result of substances taken, such as sleeping pills or prescribed amphetamines.
Manic and Depressed Episodes
- During the manic episode, patients may feel a more-than-normal elevated mood. They could have high energy, difficulty focusing on one project, and require lots of physical or sexual activity. Some manic episodes may require hospitalization to protect the patient from harm to self or others. When the depressed mood sets in, patients will have little to no energy to complete even the most basic of daily tasks. Patients could be filled with feelings of guilt, self-doubt and even thoughts of death. The DSM-IV reports that 10 to 15 percent of bipolar patients complete suicide. Whereas the manic and depressed phases typically last for at least 3 weeks, a Mixed episode involves these episodes lasting a week or less at a time before transition. Mixed episodes are often attributed to Rapid Cycling Bipolar Disorder.
- There are subtypes to Bipolar Disorder. Bipolar 2 disorder tends to have patients that never reach a full-on manic stage. Instead, they have a hypomanic episode where the mood is elevated and energy is higher than normal, but more easily controlled. Bipolar 2 patients also experience longer and more chronic depressed episodes. Rapid Cycling Bipolar Disorder patients will experience at least 4 episodic changes within a year. Mood swings that happen within a day are referred to as ultra-ultra rapid cycling episodes.
- Other disorders are commonly associated with Bipolar Disorder patients. It isn't uncommon to find people with panic disorder or social phobias to also have bipolar disorder. Physical ailments such as anorexia, bulimia and nervosa are also associated. Although substances cannot directly contribute to a manic episode substance abuse as a whole can contribute to Bipolar disorder.
- Approximately 90 percent of diagnosed patients who have manic episodes will have a recurring episode, while 10 to 15 percent of teenagers that experience a depressive episode will develop Bipolar 1 Disorder. Men and women are equally diagnosed with Bipolar 1 Disorder. Men tend to have manic episodes before the depressed episodes. During postpartum, women will more likely develop psychotic-related episodes. Premenstrual periods can worsen all episodes.
What do you think? Does this sound like it describes your situation? The idea is that the mood swings back and forth unpredictably, with some quicker than others. Here's a quote from the DSM-IV: "Sometimes individuals experience severe mood swings from periods of extreme depression to periods of exaggerated happiness. This is known as bipolar disorder or manic-depressive illness, an illness that involves episodes of serious mania and depression. The individual's mood usually swings from overly "high" and irritable (mania) to sad and hopeless (depression) and then back again, with periods of normal moods interspersed."
I mentioned managing BD above. I think this is so important. I'm going to start with a book. Get it from the library and start it right away even as you work with your parents and doctor on getting the thorough evaluation. In my practice, I use the resources with people with BD from Mary Ellen Copeland. I have found her work easy for people to use and easy to keep with you. The biggest problem is forgetting to keep to the plan when times are good and then something happens! Copeland also had BD and was hospitalized. She's a therapist and developed a BD treatment protocol called Wellness Recovery Action Plan (WRAP). Here's the book I have people start with.
The Depression Workbook: A Guide for Living with Depression and Manic Depression by Mary Ellen Copeland. Amazon: http://www.amazon.com/Depression-Workbook-Guide-Living-Second/dp/157224268X/ref=sr_1_1?ie=UTF8&s=books&qid=1284317815&sr=8-1-catcorr
Now here's a YouTube search I've put together for you on the WRAP program. I want you to look at the videos and see what you think:
The video with Mary Ellen is a bit strong but worthwhile. Okay, so you see I hope my point here for you:
Okay. Cody, this is very important that you've gotten to recognizing you need help. Show my answer to your parents and your doctor and get the help you need. I wish you the very best!
Please remember to click the green accept button. Feel free to continue the discussion; my goal is to get you the best answers possible. Bonuses are always appreciated! If I can be of further help with any issue, just put "for Dr. Mark" in the front of your new question, and I'll be the one to answer it. All the best, XXXXX XXXXX