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MN Psychiatrist
MN Psychiatrist, Psychiatrist
Category: Mental Health
Satisfied Customers: 792
Experience:  Physician for 17 years, adult psychiatrist for 13 years working with a wide variety of patients.
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My 22 years old daugther has been ill with signs of severe

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My 22 years old daugther has been ill with signs of severe depression during 5 months. Untill that she has never shown any signs of mental illness. There is no known pscychologic trauma. She is normally af very well functioning young girl with good social relationsships. She was going to start her medical study on the University of Copenhagen when she got ill. Her mental function and mood shifts from deep depression to normal function every second week, despite of anti depressive medication. During the last 5 months there has been 6 shifts. The change comes within 24 hours. Since 2 weeks she is medicated with Escitalopram 10 mgs daily and Venlafaxin 300 mg s daily. Despite of that she has been severe depressed for more than 10 days. We have not observed any manic episodes. Her psychiatrist has mentioned the possibility of "rapid cycler" as a diagnosis. Do you agrre with that based on my description? What is the best treatment for that condition? Yours sincerely *****  XXX XXXXXXX
Submitted: 5 years ago.
Category: Mental Health
Expert:  MN Psychiatrist replied 5 years ago.
Hello, I am a psychiatrist.

To answer your question, she could well have "rapid-cycling" bipolar disorder, although it would be pretty unusual to not see any hypomania/mania. If she has bipolar disorder type 2, however, you wouldn't expect to see clear-cut mania; these patients only get hypomanic (feeling very energetic, talkative, impulsive, yet still rational in their thinking).

It is also possible that if she does have a bipolar disorder and it is just developing, that the hypomania/mania will emerge over time.

If she is rapid-cycling, then the anticonvulsant-type mood stabilizers (such as valproic acid and carbamazepine) tend to work better than lithium. Lamotrigine is also a reasonable option, as it is often quite helpful in bipolar patients who are depressed much of the time.
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