Question: Dear Sir,

I write to you to obtain advise on the condition of my wife. She is 31 years old.

For the last 6 months, she has been experiencing repeated bouts of depression. Infact it is like a cycle of depression followed by a phase of being very upbeat and happy.

Depression time:
- She cries inconsolably for hours and hours
- Her crying is accompanied with extreme anger in which she speaks in a virulent language and accuses people around her for causing her depression and building anger in her
- If I try to reason or argue with her during this time, she becomes angry and hits herself and throws things around
- She also repeatedly asks the same question again and again, irrespective of how many times I try to answer it
- In two such times she completely lost her cool and tried to pull out kitchen knives to kill herself
- She constantly complains of feeling worthless
- She hits herself during this time (banging her legs into the bed, slapping herself, suddenly falling on to the floor etc).
- She cant sleep during this time at all, she remains awake whole night- or if she calms and falls asleep sometime early morning (2 am) she wakes up with a start in a couple of hours and is back to her angry self immediately
- This depression slowly starts to build and I am able to now notice some distinct signs such tiredness on her face and eyes just before it starts
- The entire thing lasts for 5-7 days and during this time she has relentless anger, accusation and crying

Normal time:
- Once the depression time passes, I notice her becoming upbeat and happy in a matter of hours
- She then is suddenly very loving and even childlike happy
- Even her voice modulation changes and she talks almost like a loving child
- However, this phase too only lasts for a week at best

Transition time:
- Post the normal time, I notice her slowly changing- from being elated to sober and quiet
- Then she invariably starts feeling anger against someone or the other (right from my mother to even the maid or neighbours)
- These are generally feelings of somebody trying to show her down or insult her in some manner
- She harbours these feeling for a few days and then again the sleeplessness and waking up at odd hours in the night begins- eventually leading back to the depression time again.

This pattern I have helplessly observed over and over again in the last six months, repeating itself. Her menstrual cycle is generally during the normal time, i described above.

I am quite clueless as to what is happening, I have tried to suggest her to see a physician, but even this suggestion really makes her very angry. As a result now I have given up talking about consulting a doctor with her altogether.

She is otherwise in very good health, with no other apparent problem or sickness at all.

I am stuck in this situation with no idea of how to handle it and what it is really. I need your advise on:
- What is this behaviour really?
- How do I handle her when she is in her depression time?
- Given her complete refusal to seeing a doctor, how or what can I do really?

I seek your advise.

Regards
XXXXXX
Sector 57, Gurgaon
0000

Dear Dr. Mittal

Thanks for your advise on my query. It gives me some sense of the issue and I hope to take the actions on initiating treatment with a psychiatrist.

As mentioned by you, regarding home visit of psychiatrist. Would you be able to recommend a psychiatrist who undertakes home visits? It would be helpful, as I could then go and XXXXXXX the doctor and post that invite him for a home visit to see see my wife.

Would really appreciate if you can suggest some psychiatrist.

Regards,
XXXXXX
Gurgaon, Sector 57.

Dear Dr. Mittal,

Thank you. I will call you as suggested on Saturday and fix up the home visit on Sunday.

Thanks again.

Regards
XXXXX