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Dr. Z
Dr. Z, Psychologist
Category: Mental Health
Satisfied Customers: 10628
Experience:  Psy.D. in Clinical Forensic Psychology with a background in treating severe mental illnesses.
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I am having a really rough night. My doctors and therapists

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I am having a really rough night. My doctors and therapists are trying to figure out what is going on with me and they are thinking bipolar 2. I have been really, really low for about a week, no energy, crying, forgetting to eat, calling out of work, I woke up feeling that way this morning, and now all the sudden I feel wired and mad and upset. Am I making this up in my mind? I don't want to email my doctor because I don't want them to think I am making this up for attention. I don't want to tell my mom, she's already worried sick about me, and my boyfriend needs to sleep because he has to work all day tomorrow. I don't know what is wrong and if this is typical?? Im scared to let my mind go because it is like there is loud music playing in it, and I can't think good thoughts. Its all mad, and destroying things, and bad. its like Ive been possessed or something. I'm not going to do anything-but this is what is going on in my mind. What do I do?

Dr. Z :

Hello

Dr. Z :

I believe I can help you with your concern

Dr. Z :

I am so sorry that you are feeling this way, I can understand how distressing this must be for you

Customer:

Its really really maddening

Dr. Z :

You mention rapid mood swings that you have been having...have they been primarily of negative symptoms like anxiety, anger, sadness, stress?

Customer:

yes, I was sad, sad, sad for about a week, and now I can't stop my thoughts from moving quickly and its all negative, I guess anxiety but it feels a little less controlled than that. Like I need to get up and do something but I can't figure out what to do and that irritates me. I am so sick of this, and I cant stop thinking about dying

Dr. Z :

So you mention that you have these mood swings, how often would you say they shift?

Dr. Z :

Do they shift within months, weeks, hours, etc..?

Customer:

its very random. I will have a good month or two where I am even, I would say they shift within weeks

Dr. Z :

So you mention a lot of negative symptoms, any happy and euphoric symptoms at all or is that very rare?

Customer:

I have symptoms of hypomania, where I feel good, will sign up for marathons, take on too much responsibility at work, dye my hair, spend way too much money, and this happens often too. Its almost like hypomania for a month and then my mood shifts...but the shifts are dramatic and they happen frequently. At one point my doctor threw out borderline personality disorder, but another doctor "I don't present that way" its all very frustrating when I feel like this it makes it even worse

Dr. Z :

It could very well be Bipolar 2 with rapid cycling, but the hypomania for a month is odd as hypomania episodes do not typically last that long. I also believe that Borderline Personality Disorder (BPD) is a better fit for your symptoms because it appears most of your mood shifts are of negative symptoms, which is indicative of BPD and also you have self-destructive thoughts of dying too.

Dr. Z :

You mentioned that you have tried a lot of medications, what have you tried?

Dr. Z :

Also for you because you are a difficult case with some overlapping symptoms, I would run Psychological Assessments on you, has that been done?

Customer:

Lithium, lamictal, saphris, Seroquel, wellbutrin, abilify, Prozac...more I can't remember, what kind of physchological assessments (so I know what to ask for)

Dr. Z :

Also impulsivity is associated with BPD too, so it can appear as hypomania to some.

Dr. Z :

Yeah the two ones I would use on you to confirm a diagnosis would be the Personality Assessment Inventory (PAI) or the Minnesota Multiphasic Personality Inventory Second Edition (MMPI-2). Now you could do one of those tests and then you want to the Millon Clinical Multiaxial Inventory-III (MCMI-III)

Dr. Z :

As for the medication, yes that is a lot. Depakote may be a better fit for you than the Lamictal or Lithium, but I am sure you have used that already

Dr. Z :

Also for therapy have you tried Dialectical behavioral Therapy (DBT)?

Customer:

Okay- thank you. I know I haven't tried Depakote yet. I'll ask my Doctor about it. I am currently in a DBT workshop. I have to admit that I almost wish it was bipolar- it sounds like there is more clear cut way of treating it. I feel a little bit trapped because nothing seems to be working and there has been a lot of difference in opinion between my doctors. Thanks for your input.

Dr. Z :

Well it is a difficult situation you are in, but it appears the doctors have narrowed it down to Bipolar or BPD, so that is something good. Your symptoms seem more indicative of BPD in my opinion. But the way you describe the cycling of some symptoms can be suggestive of a Bipolar diagnosis, but with rapid cycling. The Rapid Cycling is a tough diagnosis to catch and not many clinicians can. But regardless the DBT and the mood stabilizer are good treatments for both disorders

Dr. Z :

Is there anything else I can assist you with tonight?

Customer:

Okay, thanks again, this was very helpful.

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