Diagnose my depression

July 29, 2007 1:01 PM

What kind of depression is this?

Help me diagnose my lifelong depression. I'm going to see a doctor about it this week, for the first time ever, but I'd like to know what I'm talking about. I'd also like to know what kind of treatment he'll suggest (I'm in the UK so will be offered NHS treatments). What should I expect for the long-term treatments (all the way until I die)?

My symptoms are:

- swinging from highs to lows, sometimes as quickly as every three days. These are NOT severe highs/lows, and I know some people suffer very badly. When low, I find it hard to work and the housework is left undone. When high, all my ideas seem like good ones, and I'm cheerful, and I have a clean house. When low my memory is poor and I'm a little muddle-headed. When high, my mind is sharp (it feels that way, at least).

- dwelling on the past when I'm low. I constantly recycle embarrassing incidents from my past, some from as long ago as when I was a school kid. I know this is a stupid thing to do but I'm constantly driven to it. It's even got to the stage where I physically flinch when these thoughts come.

- overeating; eating when I don't need to, sometimes to the point of discomfort. I'm overweight but not seriously.

posted by anonymous to health & fitness (14 comments total)

There may be more than one type of illness you will be confronting. The first you described sounds like classic bipolar depression. That may be coupled with an eating disorder. I don't know of any one single diagnosis that encompasses all three of your symptoms.

Good for you for getting the aid you need!
posted by Sassyfras at 1:07 PM on July 29, 2007

My previous post wasn't very clear.

I just meant to say that you may not have one clear cut diagnosis but perhaps other diagnoses as well (bipolar and an eating disorder) and maybe your other symptoms could be lumped under bipolar (or whatever) as well.
posted by Sassyfras at 1:30 PM on July 29, 2007

IANAD but I think the diagnosis might depend on your behaviour when you are on a high. If you act irrationally (for example spending lots of money or taking risks which you would not normally take) it may be bipolar disorder . From what you described though it sounds more like atypical depression . If you want the best possible diagnosis from the doctor I would recommend writing down your feelings and actions when you are both on a high and feeling low. That way the dr will be able to base his diagnosis on more than a subjective opinion.
In terms of what you can expect from the dr it really depends on the attitude that s/he has. Some drs prescribe counselling, in which case they will book you an appointment at a local hospital or centre. Some will prescribe drugs, the most common of which is Fluoxetine.
I know how difficult it is to seek treatment for mental health difficulties so well done on making the appointment.
posted by Laura_J at 2:26 PM on July 29, 2007

You've said that you're worried your symptoms indicate depression. And since it sounds like you're going to see a doctor (a psychiatrist?), you want to know what to expect. IANAD yet, and I don't want to type a textbook, but here's a very common set of diagnostic criteria for major depression is known as SIGECAPS. Apparently, it was developed by Massachusetts General Hospital, which is pretty damn respectable in the U.S.A. I don't know if SIGECAPS is used in the U.K.

Suicidal Ideation (the wish to kill oneself)
Interest deficit
Guilt
Energy deficit (feeling fatigued/depleted)
Concentration deficit (being unable to focus, etc.)
Appetite changes
Psychomotor retardation or agitation (moving and reacting more slowly than normal, for example)
Sleep changes

In depression, your sleep/appetite can go either up or down, depending on whether it's typical or atypical. But anyways, when you go to see the doctor, be prepared to answer questions on all these (potentially uncomfortable) subjects.
posted by desiderandus at 2:39 PM on July 29, 2007

The treatment you get will really depend on your doctor. Its very hit and miss.
You may get any or all of these:

- a 'depression inventory', basically a test to see if you're depressed - which you're probably not (by the criteria of the test at least, symptoms must be present for at least a 2 week period and mostly focus on the 'low' symptoms)

- anti-depressants , likely prozac to start with

- appointments with a counsellor/psychologist - frequency varies

- referral to a psychiatrist - remember you GP is not qualified to diagnose or treat serious mental illnesses

Given that by your symptoms you don't seem to be a serious risk to yourself or other people, so your GP will probably give you prozac and tell you to come back in a month, if they're not working they might switch your meds or tell you to give it another month, if they're still not working you might get therapy or a referral.

Level of care on the NHS varies massively from doctor to doctor, particularly for mental health issues, if you're not happy with their diagnosis or treatment, try a different GP.
posted by missmagenta at 2:44 PM on July 29, 2007

IANAD, but it sounds like Bipolar II, which has the ups and downs, but not so severe that there is any psychosis. Look up Bipolar II and hypomania.
posted by la petite marie at 3:39 PM on July 29, 2007

Powercat:
How about trying to switch your thought process from bad thoughts to happy, joyful thoughts. Are you able to have some control over it?
Try to think of the good things you've done, listen to upbeat music, etc. Maybe you can avoid a lifelong or being drugged.
As for overeating, why not try eating fruits when you have the munchies?

In general, if someone has long-term depression this can have chemical, rather than purely emotional or mental causes. You can't think yourself happy; you need medicine to fix your brain so it has the right chemicals again. That's not all, of course; once you have the right chemicals, that's when it's time to start working on a positive attitude.

You wouldn't tell someone with poor vision to just try looking harder, would you? Would you tell someone with non-working legs to just "flex them" or something? If someone's mind is not working well, it isn't working well, and it needs external help. You can't fix a problem that's in your mind with your mind--not easily, anyway.

I know people who were depressed and miserable a lot of their lives; some of the bipolar, some of them just depressed. Many of them tried all kinds of things to be happy: thinking positively, being active, working on having good thoughts. I have ADHD. My parents tried everything to get me to be a normal person--exercises, diets, meditation, spine realignment, therapy, regimens, vitamins, group counseling. You know what finally worked? Medication. Once I took the medicine, that's when I could finally observe my world like a normal person. That's when I could start changing my behavior and interacting with people on a more rational basis.

I'm a bit tired of people still looking at problems in the mind as something that a person can fix in themselves. Just because you can't see it doesn't mean it isn't real, and just because it's in my brain doesn't mean it's all in my mind.

In answer to the post: I agree with the bipolar guess. If your doctor prescribes medicine (and this is very likely for bipolar disorder) get very clear details from him or her about possible side effects and dosages. Many of the medicines prescribed for this can have very strange side effects. Also, you will need to take them constantly, you can't just take them on "bad" days because in most cases these medicines work by changing your body chemistry long term, which means you need to keep taking the medicine for a while before the chemistry change happens. The side effects if you go off of them can be considerable. I suppose these are withdrawal symptoms but they're not like the kind you'd have from cigarettes or illegal drugs--instead, you feel like you've come down with a bad case of influenza. So when you talk to the doctor about the medicine, talk about the side effects when you're on the medicine, but ALSO ask if there are side effects if you go off the medicine. You'll need to know that if the medicines aren't working.

Oh, and if anonymous is eating to the point of discomfort, it hardly matters if s/he is eating fruit, chips, or road clay. The problem is that they're eating to much food, not too many calories.
posted by Deathalicious at 3:46 PM on July 29, 2007 [1 favorite]

Sounds like classic Borderline Personality Disorder. Mood swings aren't severe enough nor long enough for bipolar, binge eating is common. BPD is fixed with cognitive therapy unfortunately...not some neat little pill.

However I am not a doc.
posted by meeshell at 3:47 PM on July 29, 2007

I doubt it's BPD. The OP would be mentioning a bunch of other stuff, I think. Check out Wikipedia's explanation.
posted by salvia at 4:12 PM on July 29, 2007

In general, if someone has long-term depression this can have chemical, rather than purely emotional or mental causes. You can't think yourself happy; you need medicine to fix your brain so it has the right chemicals again. That's not all, of course; once you have the right chemicals, that's when it's time to start working on a positive attitude.

You wouldn't tell someone with poor vision to just try looking harder, would you?

I think you're selling cognitive therapy short. The longer you've been depressed, the more likely you are to have negative thinking "habits" that you have to train yourself to break. This may or may not go hand-in-hand with pill-based therapy or more intensive personal therapy.

This is quite separate from the often misguided advice non-depressives give, the classic "snap out of it" lines or attributing depression to poor character.

Frankly, I needed Prozac at a point years ago to break a longstanding multi-year cycle of highs and lows, with the lows seeming lower every time. But I needed cognitive therapy to maintain my mental health long after I went off medication.
posted by dhartung at 5:49 PM on July 29, 2007

You could have rapid-cycling Bipolar II disorder or cyclothymia.
posted by lunalaguna at 6:29 PM on July 29, 2007

I think lunalaguna has it.

(The answer, not the illness.)

If your doc prescribes an antidepressant have a close friend keep an eye on you for a week or so. If you are really bipolar you might wind up getting very hyper and that can be problematic.
posted by konolia at 8:03 PM on July 29, 2007

I'm going to see a doctor about it this week, for the first time ever, but I'd like to know what I'm talking about.

Don't go in trying to convince your doctor that you know what you're talking about, because if you don't, you might cause him to misdiagnose you.

It's just like getting a car repaired; if you KNOW it's a broken XYZ, that's fine, but if you only suspect it's a broken XYZ because people on the internet told you so, the mechanic might never discover that it's actually a worn-out ABC -- even if it might have been obvious if you'd simply described the symptoms to him.

So document your illness as best you can from a first-person diary perspective, but don't try to diagnose -- let your doctor do that.

I'm not trying to discourage you from doing research and getting informed; just don't go into your doctor pretending you truly know what your problem is.
posted by davejay at 11:03 PM on July 29, 2007

Frankly, I needed Prozac at a point years ago to break a longstanding multi-year cycle of highs and lows, with the lows seeming lower every time. But I needed cognitive therapy to maintain my mental health long after I went off medication.

This is pretty much what I was saying -- people with bad brain chemistry need to get good chemistry going, and then they can use various mental and emotional work to stay mentally happy and healthy. But it seems to me that right now in the US you're either a drugs-cures-it-all person, or a drugs-totally-unnecessary-it-is-not-real-snap-out-of-it person. Very few people are like, "take a pill for balanced brain chem, then get introspective and/or positive".
posted by Deathalicious at 3:44 PM on July 30, 2007