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Is it dysthymia & bipolar, or cyclomania?
Nov 25, 2013

Hi. I have been battling depression for many years. I am 42 and was diagnosed as Bipolar at age 9. I have been on a variety of psych meds from Prozac to Celexa to lithium. Everything seems to help for a bit but soon wears off. I am now on Sertaline and Complera. Recently I have had a lot of stress at home and work and just feel hopeless all the time. I even had an episode at work this week that resulted in a broken office door. I have even had some SI recently, but just wish I could be in a bad accident and killed instead of doing it myself. My HIV specialist insists the HIV and meds have nothing to do with it, and my family doctor keeps telling me to talk to my HIV specialist.

My insurance won't let me get psych treatment without a referral but I'm at a loss. I also make too much money for free psych services, but not enough money to pay for treatment (especially hospitalization). Who do I talk to and what do I say to ensure neither are poo-pooing my psych problems? Is it possible I have a misdiagnosed underlying problem like cyclomania or dysthymia? Suggestions are appreciated. My VL is consistently undetectable and my CD3/CD4 counts are consistently within normal limits.

Response from Dr. Fawcett

Thanks for writing. I'm sorry to hear that you are experiencing such difficult mood complications. A case as complex as yours requires a thorough assessment followed by ongoing monitoring. For this reason, it is really important to advocate for the necessary referrals to be certain that you get the care you need. Coordination of care is an essential "best practice" element and it is really disturbing that you cannot get responsible consideration of your concern. You may need to start speaking with supervisors at your insurance carrier and strongly make this point with both your family doctor and your HIV provider. You are certainly well-informed about your case and I believe you are your own best advocate.

As for the broken office door and other stress, I would recommend psychotherapy in conjunction with the medications. There are very effective tools you can utilize to reduce your stress and manage it. Of course, any thoughts or plans of suicide should be immediately addressed with your healthcare provider or, if necessary, 911.

Best wishes to you,

David



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