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Question
Posted by: Eve | 2004/09/21

Depression, Dysthymia & Bipolar Disorder

What are the differences in symptoms in these three?

I have been suffering from depression for 14 years now, and have had a few major depression episodes (for which I have been hospitalised), but cannot remember a time when I have not felt depressed (ie unhappy, 'down'). I have tried to commit suicide 3 times (unsuccessfully, for obvious reasons :-))

Lately I have been experiencing episodes where I will feel very upbeat for a few days or a week or two, and then suddenly I will be very depressed again. This could probably also be hormonal, since I suffer from POCS, and I am not currently taking any medication for this.

I have had some very bad experiences with psyciatrists and psycologists in the past, and I am also not very keen on taking anti-depressants. In the past I have taken Aropax, Effexor, Prozac and Zoloft, but I cannot honestly say that I found that they helped in any way, except for numbing all feelings and/or intensifying the suicidal thoughts.

Currently I am feeling very suicidal. I have recently been demoted because I could not cope with the very stressfull environment that was part of my job. I am currently not very happy in my job.

My relationship with my family is very good, but outside of that I do not have any real relationships, except for the colleague/superficial type.

I also do not have a medical aid. What are my options as to determine what exactly I am suffering from, and what are the treatment options, except for the obvious psycologist/anti-depressant routine?

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Our expert says:
Expert ImageCyberShrink

Hello Eve,
That's actually a very complex technical question I haven't the space here to answer in full. Elsewhere in this site you'll find a good description of these disorders. Basically, Depression is clear ; Dysthymia is a somewhat milder depression, spread out long and thin, lasting longer ; and Bipolar Disorder is normal Depressions which recur, but also includes episodes when your mood goes in the opposite direction, and becomes far too good, too energetic, too happy and unthinking.
Some people talk of a "Double Depression" when there is Dysthymia AND episodes of Depression on top of it.
The more recent addition of some u[pbeat episodes is harder to assessm without the benefits of a thorough examination and assessment. These could be simply small outbreaks of "normal" among the regular gloom. In Bipolar Disorder the shifts in mood are not so small and rapid --- a manic episode comes on over days, and lasts for days or weeks, even months, the mood shifts don't occur within a single day.
Sorry to hear that you've had bad xperiences in the past with psychiatrists and psychologists, but it really is worth continuing to search for one with whom you can work really well, and exploring differing combinations of treatments to find what works best for you. Similarly, persist in seeking out a psychologist who uses CBT ( Cognitive-behaviour Therapy ) as this might suit you well, either alone or in combination with a careful choice of medications. And clearly the continuing job stress must be playing a part. Really, though it may sound like more of the same, what is most likely to help is seeing a good local psychiatrist for a fresh re-evaluation of the whole situation, a re-assessment, and a discussion of treatment options. There are groups of antidepressants you haven't tried yet, as well as CBT. Apart from ACT / Shock Therapy, I'm not aware of any effective treatment for depression that doesn;t involve medications or talk-therapy / counsellign.

The information provided does not constitute a diagnosis of your condition. You should consult a medical practitioner or other appropriate health care professional for a physical exmanication, diagnosis and formal advice. Health24 and the expert accept no responsibility or liability for any damage or personal harm you may suffer resulting from making use of this content.

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Our users say:
Posted by: Eve | 2004/09/23

Thank you for your reply.

As I've mentioned, I do not belong to a medical aid, and since having been demoted there was a considerable cut in my salary, so I will not be able to afford private healthcare at this stage, even if I could see past this problem/fear I have of mental practisioners.

That only leaves the state institutions, which I have also toured quite extensively previously, and, unfortunately, is just a big waste of time, as the public healthcare system is far too overloaded to afford time for quality treatment for mental illnesses.

I lost a friend to a combination of bi-polar disorder and non-treatment from a very well-known state institution who just put him in a ward, drugged him, and forgot about him. After six months he was allowed weekend passes, and he eventually committed suicide during one of these weekends.

The CBT sounds very promising, I have read up on it after your reply, but I will not be able to get any such treatment until my financial position improves. In this country you can only afford to have a mental illness if you are very rich.

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