So, I’m really concerned about someone that is very close to me… She’s been diagnosed as having Severe Atypical Depression and I hate to second guess her shrink, but I think he’s wrong.

A little note:

I won’t mention her name or even an initial. Although I do keep this journal a pretty good secret from most people, I’d hate for someone who knows the two of us to eventually put 2 and 2 together. Not that talking about this sort of thing is bad, but so many people are quick to judge and label this type of thing … I’m just going to keep it as anonymous as possible.

I’m going to describe her from my point of view and share a few insights that she’s given me. I’m going to try and do this in a way that’s very neutral — Not holding back, but not judging her behavior either. It’s going to be a bit difficult as, I’ll admit, I’m very biased.

Since I don’t outline anything I write, and I try not to revise too much, this may come out as a bunch of randomness or a cohesive group of statements. Neither you or I will know ’til I’m done writing it and you’re done reading.

Ok, so I think the Dx is wrong. Since the Dx is wrong, the Rx is (probably) wrong. In the end a bad Dx + a bad Rx probably = a pointless spinning of wheels and a liver thats getting pounded for no reason.

Sometimes she really does fit the Dx of someone that’s severely and chronically depressed. Lets run down her behavior and make sure we agree. She:

• Feels helpless and empty.
• Hypersomnia (Sleeps forever sometimes, Insomnia others).
• Endless self-loathing.
• Unable to feel pleasure — of any kind.
• No energy.
• Suicidal thoughts … and unfortunately intentions.

All those typical indicators … All the obvious things you’d tell your PDoc about, right. Now here’s where the problem starts… Despite having all those indicators she also:

• Becomes extremely irritable.
• Talks on ten levels of tangents.
• Makes lists and gets ultra organized (We’re not talkin’ about your average make a shopping list behavior).
• Doesn’t “Give a shit” — not in the depressed, just don’t care way, but in the aggressive intentional distancing way.
• Things are very black and white — there is no gray area.

While I can see these things as indicators of a manic state, from our conversations I don’t think she’s aware of these things a lot of the time. In not being aware of them (to the extent that a 3rd party like myself or others around her are) I don’t know that she expresses them to her PDoc — which I think may be a common reason for mis-diagnosis of a bipolar patient.

Now, lets add some alcohol. Yeah, she likes to party a bit — as do I. So when we add a few drinks we get all the above behavior — both the depressive and the manic. Usually the cycle goes from a daily/weekly rotation to a washer on the spin cycle. Sometimes she’ll go the whole night in a good place, sometimes it’ll be a bad place — but both sides are elevated 100%.

To make things worse — she gets pretty neurotic … Now, most of us are neurotic to some extent, and for many of us this behavior is magnified when we’re intoxicated so maybe this isn’t an indicator of anything at all, but sometimes I wonder.

“He is incapable of holding an external dialog. Even when he seems to be interacting with someone else – the narcissist is actually engaged in a self-referential discourse. To the narcissist, all other people are cardboard cut-outs, two dimensional animated cartoon characters, or symbols. They exist only in his mind. He is startled when they deviate from the script and prove to be complex and autonomous.”
– Sam Vaknin

Although that quote only describes her when she’s really has too much, it does (from an outside and much more sober point of view) seem like the places she’s coming from. In her defense, I have seen the world from that place once or twice (or 10 times) after having a few too many as well, so again — maybe nothing.

Ok, so … Thats where I’m gonna stop. I’m distracted and having a real hard time writing much more about it — I’m even pondering deleting the last few paragraphs, but since I don’t really want to censor myself I guess it’s gotta stay.

What it all boils down to is that I’m worried about her.

Her current Rx (Effexor, Lamictal and one other med I can’t remember) isn’t working so she’s weening off the Effexor and on to Cymbalta (Quickly moving up to 30mg BID instead of trying 20mg BID to start).

Her suicidal confessions to me the other night.

I just can stand to see my best friend in this state. And I surely can’t stand by just watching and waiting if I think she’s been mis-diagnosed.

I’m guessing if anyone reads this they’ll have an opinion one way or the other — Tell me what you think.

Don’t try and make light of it please — Feel free to be negative about any other post on the site, but not here. If you can’t be constructive, I’ll kindly ask you to shut the fuck up.