Is there something else going on other than depression

Patient

Q: Hello
I was diagnosed about 20 years ago with depression, I didn't get the right treatment for it then, but about 15 years later I did. For the last 5 years I have been on medication for my depression, but I feel as if things are not working properly still, its as if my mental health is getting worse rather than better, especially in the last 3 years. I find myself being impulsive, irrational, anxious, irritated and angry sometimes, my thoughts constantly race about the same things over and over, and other times I find myself to be depressed and tearful. It seems to have gotten worse over the last couple of months where I will have about a week where I am feeling good and able to do things like exercise and eat healthy but then I will all of a sudden fall off the wagon for no reason and just have zero energy or motivation to do anything. Should I be looking at changing my medication? I wonder if something else psychologically is happening with me, I do see a definite pattern with me of mood swings and ups and downs, but I thought the medication would help with that. Currently on 187.5mg of Venlafaxine per day.

Symptoms:  Irritated, impulsive, angry, thoughts racing
Doctor

A:   Hello
Thanks for using "Ask The Doctor" for posting your query.
The symptoms that you have mentioned, the duration of illness that you are having and the nature of cycling that you have noticed, suggest you may be having a bipolar depression. This is different from the unipolar depression and doesnt recover only with the antidepressant. Venlafaxine is a good drug for unipolar depression but for bipolar depression, mood stabilizers are the drug of choice along with antidepressants. The common drugs used for this illness is lithium 400mg-1200mg, Valproate 500mg-1500mg or oxcarbazepine 300mg-900mg. These medications are also used in treating resistant depression and hence worth a try.
These medicines generally start acting in 3-4 weeks and if its bipolar depression then the symptoms should start reducing.
Do meet your doctor and discuss these new medications.
Hope this helps,
Wish you a good health.

Comments / Follow Ups

Patient: thank you very much for your help, I will be visiting with my doctor tomorrow to discuss this.
Regards
Patient: could you please tell me, would my doctor be able to diagnose me or is this something that a psychologist or psychiatrist needs to answer, also does a diagnosis take time?
Doctor: Hello
A regular doctor should be able to take care of you.
If required he may refer you to a psychiatrist.
The diagnosis will require a careful history for 20-30 min abd thats it.
Regards

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