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Dr. Z
Dr. Z, Psychologist
Category: Mental Health
Satisfied Customers: 10547
Experience:  Psy.D. in Clinical Forensic Psychology with a background in treating severe mental illnesses.
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16 y.o. Constant mind changing, minimal communication with closest family, history of majo

Customer Question

16 y.o. Constant mind changing, minimal communication with closest family, history of major depression.
Using Abilify. Severity of inconsistency increased after put on abilify.
Any suggestions
Submitted: 1 year ago.
Category: Mental Health
Expert:  Dr. Z replied 1 year ago.
*This website DOES NOT constitute treatment and only provides information and advice. For treatment (therapy and/or medications) you must go to a licensed professional in your area. Please note that anything said here is not private or confidential, as this is a public forum.
Hello, I am sorry that this 16 year old is experiencing these symptoms, I can understand why this would be disconcerting. I would like to ask a couple questions to get a better idea of the situation, so that I can better assist you.
1. You did not pose a question in your description, so what exactly is your mental health question that you require assistance with?
2. What dose of the Abilify is this individual currently on? Why was this individual prescribed Abilify? And is this individual using any other psychotropic medications?
Customer: replied 1 year ago.
What is possible diagnosis and prognosis for the problem. Does Psychotherapy is possible may help
Dose of Abilify was initially 10 mg (started in Feb 2015 for about 1 month) and after that slowly reduced to 2.5 mg (current dosage). Treating psychiatrist mentioned Bypolar.
Expert:  Dr. Z replied 1 year ago.
There are many possibilities for a diagnosis as Abilify is an atypical antipsychotic medication, but the since the only symptoms you have listed are constant "mind changing," and minimal communication with friends and family than a Major Depressive Disorder should be considered as the most likely diagnosis. There is also a possibility for Schizophrenia or another Psychotic Disorder if this individual is displaying Negative Symptoms, which describe behaviors of isolation, anhedonia, flat affect, low energy, and apathy. But if this individual does have a Major Depressive Disorder, why was he only being treated with Abilify as that medication is considered an augment to an antidepressant. Also if this individaul does have a Psychotic Disorder than the dose of Abilify is too low.
Concerning the Bipolar Disorder...Typically an individual with a true Bipolar Disorder will have cycles of Mania/Hypomania (symptoms include anger, irritability, increased energy, grandiosity, racing thoughts, pressured speech, less need for sleep, impulsiveness, and recklessness) that last for a few days to a few weeks. Than the individual will either go into a Euthymic State (normal mood functioning) for an indeterminate amount of time or a Depressive Cycle for a few months. If the individual goes into a Depressive Cycle, which lasts for a few months, than once the cycle is over the individual will either go to a Euthymic state or a Mania/Hypomania Cycle. Nearly 75-85 percent of people with Bipolar Disorder will have less than 3 Mania/Hypomania Cycles in a 12 month period, and anyone who has 3 or more Mania/Hypomania cycles in a 12 month period are considered rapid cycling. So far you have not described this level of behavior for this individual so it would not appear to be a Bipolar Disorder.
Overall a Major Depressive Disorder would be the most likely, but the initial treatment was not correct as a SSRI antidepressant should have been used first and a form of therapy called Cognitive Behavioral Therapy (CBT) should have been used as well. Depression can easily be resolved with the right treatment of an antidepressant and CBT therapy, than after a few weeks to a few months the medication can be stopped as the CBT techniques would have been fully ingrained and the depression would be resolved.
So I think this individual should be seen for a second opinion because the medication, symptoms, and the possibility of the psychiatrist saying this individual has Bipolar Disorder does not fit at all. I can only speculate as any diagnosis must be from a face to face evaluation, but with the two symptoms you mentioned a Depressive Disorder is the best fit.
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