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Experiencing repeated bouts of depression. Suffer from sleeplessness. What to do?

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Practicing since : 2004
Answered : 1835 Questions
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.

Sector 57, Gurgaon
Posted Wed, 7 Aug 2013 in Depression
Answered by Dr. Ashish Mittal 19 hours later
Thanks for your query.

I appreciate your efforts for medical consultation in so much distress.

Important aspects of your query are:
•     31 year old female
•     In good medical condition
•     Refusal to see doctor
•     Complaints of: episodic change in mood, sleep and behavior.

From the information it appear that your wife is suffering from bipolar disorder (Mood disorder). In Bipolar disorder patient has both manic and depression episode. It is a chronic illness. This illness occur due to neurotransmitters imbalance in brain.

In depression most common symptoms are: low mood, decrease energy and negative thinking. In contrast, in Manic episode common symptoms are: over cheerfulness, anger, irritability, increase energy and decrease need for sleep. She also have some psychotic symptoms (like Fear, suspiciousness, muttering to self, unusual and odd thinking) which can occur with depression or mania.

Medicines are primary mode of treatment for this illness. Following medicines are well researched and found to effective for Bipolar disorder: Lithium, Valproate and Carbamazepine. These medicines also called as mood stabilizers and given for for long term to stabilize mood. They prevent both depressive and manic episode. Even if patient becomes ill while on medicine, illness is less severe and last for short period.

Out of these medicines patients got stabilized on one or combination of two medicines. Choice of medicine is depend on patient illness state (which can be assessed on interview only), side effect profile of medicine, and duration of illness, weight, age and sex of the patient. Sometime other antimanic agent needs to be added depending on the severity of episode and anti depressants need to be added during depressive episode.

So, it is advisable to visit nearby psychiatrist for her assessment and treatment as soon as possible. If your wife is becoming aggressive then there is need to rule out manic episode (or mixed episode) after mental status examination by psychiatrist.

In symptomatic phase of illness patient do not have insight regarding illness as they do not considered themselves ill. Due to that they deny need for any treatment, in such cases after assessment medicines can be given in form of depot injections or medicines in food (syrup or tablets) after home visit of nearby psychiatrist. In severe cases patient may need short term involuntary admission in psychiatric nursing home.

I hope this information has been both informative and helpful for you. In case of any doubt, I will be available for follow ups.

Wish you good health.
Above answer was peer-reviewed by
Follow-up: Experiencing repeated bouts of depression. Suffer from sleeplessness. What to do? 47 hours later
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.

Gurgaon, Sector 57.
Answered by Dr. Ashish Mittal 42 minutes later
Hello again,
Thanks for follow up.

You can talk me on phone to fix home visit on Sunday as I visit Apollo Clinic sector 57 on that day.
To fix it please call in advance on Saturday between 9am and 2pm.

My number: 0000

Please accept my answer in case there are no further queries and recommend our services to your friends too if you have found it helpful.

Wish you good health.

Above answer was peer-reviewed by
Follow-up: Experiencing repeated bouts of depression. Suffer from sleeplessness. What to do? 4 minutes later
Dear Dr. Mittal,

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

Thanks again.

Answered by Dr. Ashish Mittal 34 minutes later
Above answer was peer-reviewed by
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