Reader’s Question

In the attempt to keep this short: 29-year-old female. Married 8 years — 2 kids under 10. Diagnosed with Dysthymia after devastating miscarriage of twins at 19 years old. Diagnosed with Bipolar Disorder at 24 years old. Had last child at 25 and restarted antidepressants at 26. Can’t remember anything — appointments, conversations from the day before, events from earlier same day. Kids used to be my whole life — now I don’t even want to be a mom anymore. Verbally abuse everyone in my whole family, kids and husband included. In the last two years — after being told husband was having an affair, which I never proved true or false — verbal abuse has been worse. I have begun drinking more often (almost every weekend as opposed to 3-4 times a year). Have had unprotected sex with two people I know are sexually active with several other people. Have felt very suicidal 6-7 times to the point I stayed in bed — didn’t go to work, deal with kids, or even get out of bed. Can’t stop crying.

Wish for death almost daily and imagine wrecking my car or being hit, or “fantasizing” about a serious illness. NO interest in sex or being touched by husband, dread dealing with my kids…dread going home after work each day. Yell at my kids too much, for every little thing, my oldest starts out “mom don’t yell at me please, but can I have something to drink?” which makes me feel awful and I start crying again. Same child also tells me she never knows when I am gonna yell at her and when I won’t for asking questions. I feel like I don’t want my kids or husband anymore, but haven’t admitted that to anyone. I feel like leaving will remedy a lot of the stress — but I am scared to do so.

What is wrong with me? Do I need to look into an inpatient treatment center? I can’t get into Psychiatrist for 4 months and don’t think I can wait that long.

Our Clinical Psychologist’s Reply

What’s wrong with you? Severe, chronic, “agitated” depression best fits your situation. There are several different types of depression. In your situation, you have a combination of chronic and severe depression as well as anxiety and agitation. In this situation, you are highly agitated most of the time, hypersensitive to comments/events, intensely angry/resentful/bitter, and exhibit a type of internal physical hyperactivity (restless, muscle twitches, etc.). Your brain speed is excessive and your thoughts are racing so fast that you can’t focus or concentrate properly. You are trying to cope with this situation by using alcohol, having temper outbursts, and engaging in behaviors that might briefly distract you. When we are this depressed and agitated, the brain fills up with guilty thoughts such as not loving our children, wishing evil on others, etc.

Depression is routinely treated by family and OB/GYN physicians. Your problem…your depression is no longer “routine”. You may require several medications to address the combination of symptoms. This is why a psychiatrist is needed. I would guess you’ve been treated with a low-to-moderate dose of an antidepressant when you will probably require a high dose of antidepressant as well as a long-acting antianxiety medication. Seeing a therapist/counselor is also needed in your situation. You’ve had a very difficult past 10 years.

I’d recommend:

1. Read my article on “Chemical Imbalance” on my website at www.drjoecarver.com. It describes the different neurochemicals involved in your situation and why several medications may be needed.
2. Keep your appointment with the psychiatrist…and try to get in sooner if possible. You may need to go to a neighboring city to get an earlier appointment.
3. If you are actively suicidal, I would consider an inpatient psychiatric unit. A benefit to an inpatient unit is the concept of “rapid stabilization”, including providing medications that can be continued in the community upon your release. Inpatient stays are not very long and considering the amount of agitation you are experiencing, it’s an important option to consider.
4. Consider finding yourself a counselor/therapist.
5. Recognize that your neurochemistry is very upset at this time. This will produce not only excessive thinking speed but a brain that is full of “garbage” as well. You’ll be thinking about the past, the future, be full of guilt, have suicidal thoughts, hate yourself and everyone around you, etc. — all in three minutes! Don’t make any big decisions at this time. Wait until your thinking system is more stable.

The key to fix this is treatment…not more thinking or processing.