Obsessive and depressed -- diagnosis?

Q: I AM 60 YEARS OF AGE,I AM JUST ABOUT TO RETIRE, I HAVE SEEKED MEDICAL ADVICE WHICH STATES THAT I HAVE DEPRESSION AND COMPULSIVE THOUGHT DISORDER. THOUGHTS OCCURED 21 YEARS AGO AND KEEP REOCCURING. PAST THOUGHTS HAVE BEEN IN A SIMILAR NATURE TO THIS:- WORRYING ABOUT HARMING CLOSE RELATIVES DUE TO THIS DEPRESSION. CAN YOU OFFER ANY HELP, TECHNIQUES OR ADVICE. IF NOT COULD YOU POINT ME TO A MORE SPECIALISED WEB SITE YOURS SINCERELY MAUREEN.

Dear Maureen --

Trying to make a subtle diagnosis in this situation would be a poor idea, over the internet.  So you will need to hunt down a good diagnostic psychiatrist; a university medical center will have one.  After that you can work with someone closer to home for treatments that may have been recommended. 

On the basis of what you have written the three main diagnoses to be considered would be:

1.  "Major depression with psychotic features".  This is quite common and very treatable. 

2.  Obsessive compulsive disorder.  Any time somebody talks about obsessive thoughts, this diagnosis is going to come up.  If you have some procedures, activities or ritual behaviors that you can do to make the thoughts go away, this diagnosis becomes more likely; but you can have OCD without such "compulsions".

3. Bipolar disorder.  In my view this diagnosis doesn't come up enough in the context of symptoms like yours.  Technically yours would be "bipolar II".  You can read more about that at www.psycheducation.org .  However, its' a good deal trickier to treat than major depression; you don't want it to be this, unless it really is this, in which case treating it like major depression could make it worse, actually.  So that's why that first diagnostic step is so important. 

The good thing here is that you're asking about a diagnosis and looking for some help.  Don't stop now, because all three of these are very treatable.  It could be something else, including some other medical illness now making your old symptoms worse, but from the way you describe it, I would doubt that.  Ask about a medication called risperidone, which in older folks such as yourself can work splendidly in tiny doses like 0.5 mg total per day (where the full 20-year-old's dose can be 6 mg. or more).  It might be just the thing, because making a diagnosis here is going to be a little tricky -- but risperidone could be a good treatment for any of them! (at least these 3).

Good luck and good hunting.

Dr. Phelps



Published January, 2001