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Question
Posted by: BMJ | 2012/04/04

Bi-polar

Dear Doc

Could you tell me if someone truely suffers from bi-polar depression, is there a specific time of onset. In other words, is it something that has always been with them or does it manifest in puberty /only as adutls? And is OCD commonly associated with it.

A friend of mine''s 18year old son has yesterday tried to commit suicide - for the 4th time. He is being treated for general anxiety and depression. He is a social recluse - he has not gone to school in 4 years. He is extremely ridgit, with all the typical signs of ocd - will not eat/drink/brush teeth if it has not been exactly a certain amount of minutes in between, obessivly tidies and cleans. His family is very wealthy so he never has to work, so he sits in his room all day and wont see anyone - outside the immediate family. He has no friends or social interaction. His life is completely warped. His mom wondered to me today if they are not treating him for the wrong kind of depression. She said that he was a very normal child, but things went really wrong when he hit puberty.

When he was revived, he was so angry that he was not dead and pleaded with his mom to just let him die.

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Our expert says:
Expert ImageCyberShrink

Not at all ! With Bipolar Disorder, as with most other disorders and diseases there is rarely a sudden, unambiguous starting point one might write in one's diary.
Some disorders start / first show themselves clearly in adolescence or younger, others usually at older ages. OCD is NOT commonly a part of Bipolar Disorder, though such mood disorders do perhaps occur together more often than by pure chance.
Obviously, I understand your concern about your friend's son, who sounds significantly troubled. I hope he is being assessed and treated by a good local psychiatrist, and not only a GP, as such a complex situation should never be managed solely by a GP. From yopur description, this doesn't sound like a successfully treated case of depression, and needs a re-assessment and reconsideration of the treatments most likely to be helpful.
Why not consider asking for a second opinion, from a different psychiatrist, for a fresh viewpoint ?
As Anon says, this sounds like all downs with no ups, so not like Bipolar Disorder, but there are some depressions that prove resistant to the obvious treatments, and need special consideration and treatment. Maybe an opinion can be sought from the senior staff at the Dept of psychiatry at your nearest Medical School ?
And DD is also right, that he must not be left to just sit around all day feeling miserable, but ways need to be found to keep him occupied usefully and pleasingly.

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Our users say:
Posted by: cybershrink | 2012/04/06

Not at all ! With Bipolar Disorder, as with most other disorders and diseases there is rarely a sudden, unambiguous starting point one might write in one's diary.
Some disorders start / first show themselves clearly in adolescence or younger, others usually at older ages. OCD is NOT commonly a part of Bipolar Disorder, though such mood disorders do perhaps occur together more often than by pure chance.
Obviously, I understand your concern about your friend's son, who sounds significantly troubled. I hope he is being assessed and treated by a good local psychiatrist, and not only a GP, as such a complex situation should never be managed solely by a GP. From yopur description, this doesn't sound like a successfully treated case of depression, and needs a re-assessment and reconsideration of the treatments most likely to be helpful.
Why not consider asking for a second opinion, from a different psychiatrist, for a fresh viewpoint ?
As Anon says, this sounds like all downs with no ups, so not like Bipolar Disorder, but there are some depressions that prove resistant to the obvious treatments, and need special consideration and treatment. Maybe an opinion can be sought from the senior staff at the Dept of psychiatry at your nearest Medical School ?
And DD is also right, that he must not be left to just sit around all day feeling miserable, but ways need to be found to keep him occupied usefully and pleasingly.

Reply to cybershrink
Posted by: DD | 2012/04/05

My brother was like that. Or rather he became like that after he was sexually molested by a family friend. We didn''t know about it until after he tried to commit suicide. The best thing your friend and her family can do for her son is something to keep him busy. Something he has to care for. We got my brother baby birds he had to feed with a syringe every 2 hours. Today he''s made a business out of it. But it gave him a reason to get up in the morning. To help him to know there is something depending on him. Maybe the doc has other views, but beside treating him clinically for his condition he needs something to keep busy. Sitting in your room all day with your own thoughts will drive anyone to suicide.

Reply to DD
Posted by: Maria | 2012/04/05

BMJ, I''ve mailed you

Reply to Maria
Posted by: Anon | 2012/04/05

People suffering from Bi-polar have both ups and downs, what you described here sounds like it is all downs with no periods of happiness in between.

I''m sorry, I don''t think it''s necessarily the wrong kind of illness they are treating him for as much as that they are treating his illness wrongly. Medication and counselling is not enough to treat depression or anxiety or ocd, it requires an entire change of lifestyle.

Therapy can help with that, to teach him how to view himself and the world differently and to stop bad thinking and habits, but if he is allowed to fall into his same routine of habits when he is home it will probably just interfere with any progress he and his therapist has made.

I can understand that dealing with this situation is not an easy task, but there is a point where his parents need to start giving him some tough love. It is NOT ok for an 18year old to sit home all day with nothing to do, especially not with his mental state, it''s extremely unhelpful.

If they are wealthy they should perhaps look in to finding some sort of facility where he can recieve counselling and be taken care of for a while. It might be the push he needs to recover, and the oppertunity to practically apply what he gets from therapy.

Long post, sorry, but I feel as if I was in pretty much the same boat as him. I wish someone had given me a swift, but loving, kick in the behind and it only started turning around for me when my husband went "  that''s it, enough, you will get up, we are going for a walk, right now, no excuses" 

Reply to Anon

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