Case study ( 6431 views as of May 20, 2019 )
Frank, a 55-year-old advertising executive, has started seeing his new family doctor, and reports that he has “always been depressed” for as long as he can remember, and certainly since adolescence. At different times in his life his depressions could be pronounced, and for a couple of weeks he would be isolating himself in his home, cutting off contact with family, friends and colleagues, and feeling suicidal. These episodes would usually resolve spontaneously, and he never went for treatment, except once when he was prescribed an antidepressant for a short time, but stopped it when it made him feel “more depressed and irritable”. Much of the rest of the time, his moods would range from “down and lonely” to anxious, and also highly irritable. In fact, it has been his tendency to feel irritable and to have a volatile temper that has characterized his personality, he feels, and the people who know him tend to see him as someone who can be at times passionate, driven, yet also explosive and unpredictable.
When asked about his career, he explains that he is a very successful businessman, who managed to grow a very prominent advertising firm. He describes having a capacity to get fully involved in work projects where for weeks on end he will barely get any sleep, feel full of energy, highly motivated by big business projects, highly impatient and irritable when feeling that others are not keeping up with him, racing thoughts, rapid speech, and also high libido at those times. On some of these occasions he would take very big financial risks, spend very large amounts of money on his projects but also on lavish parties, gifts for colleagues and business partners, though he never saw anything wrong in this.
This patient was referred to a psychiatrist for a consultation, and diagnosed with Bipolar II Disorder based on his reports of hypomanic episodes and depressive episodes throughout much of his life. He was found to be currently in a Major Depressive Episode. Rapid cycling was also mentioned in the diagnosis, given that he seemed to have multiple discrete mood episodes in the same year. He was prescribed Seroquel XR 300mg qpm, as well as Metformin 500mg BID to prevent possible weight gain and metabolic syndrome from the Seroquel.Author: Dr. Marc Miresco