Question: Hello, I am very confused about my condition/diagnoses. I am a pharmacist who had his license suspended due to addiction to Vicodin. I am 38, but ever since about the age of 20, I have felt depressed. In college, I realized alcohol made me feel better and some years later I was officially designated an alcoholic. Now, specifically, about 2 years ago I had a brief period where I began hearing voices (that were very real to me), and some paranoia. I was an inpatient at a psychiatric ward for 3 days. They started me on 10mg of Abilify per day. About a year later I had another episode of hearing voices for about 2 weeks. I then began seeing a highly recommended Psychiatrist (I had seen others before). At our first visit I was so depressed I cried in her office. She doubled my dose of Effexor XR from 150mg per day to 300mg per day and since I had been on Klonopin from my previous Psychiatrist she kept me at 1mg TID. I have had no other psychotic symptoms since then. I should clarify, the 2 week period of psychosis happened after I started seeing her, so initially she did not treat me with antipsychotics. When it did happen she put me on Abilify 10mg with was eventually raised to 30mg. At some point she determined I had bipolar disorder and I had experienced a manic break. She added Lamictal, eventually titrated up to 200mg BID. As the months went by, and no psychotic symptoms emerged, she said she thought I needed a stimulant because of what a lethargic, melancholic depression I had. We started low, and am at the current dose of 40mg Adderall in AM (about 6:00) and 40mg at noon. It has helped immensely. I went from someone who stayed in bed all day, to someone who can pursue goals and function relatively normally. My question among many relates to this: sometimes when she gives me my diagnostic paper (she doesn't accept insurance) she marks Bipolar Disorder, most recently mixed. Other times she marks Schizoaffective Disorder. I see her every 3 months and she requests I email her at least once a month to let her know what I am doing. However, she is very busy and rarely responds. I should add she is one of the few who are actually psychopharmacologists, and recently received a degree in biology psychiatry. She teaches and is the medical director and conducts research at her facility where she sees both clinical patients and research patients. So, she's no dummy, and I trust her. But I would like another psychiatrist's viewpoint. I am not convinced that I have Bipolar Disorder. The things I did that would be considered "manic" were usually under the influence of drugs. She explained that there can be a more irritable form of mania, which is not necessarily euphoric or grandiose. Anyway, with the complications of past substance abuse, the major anxiety I feel, and the unrelenting depression (although improved), I question my diagnosis. I question my medication regimen. What do you think? She's considered one of the best in her field, but doesn't explain to me very well my multiple diagnoses and their implications. She gives me advice on what to do and holds me accountable to achieving certain goals, but does not respond to my questions that I have posed above. Thank you for your time, and I look forward to your well-thought-out response. Take your time. This is complex.

I see what you are saying with regard to bipolar disorder. My Psychiatrist at different times has also said I was in a mixed state and that I had rapid cycling. What I don't understand is her occasional diagnosis of schizoaffective disorder. Can you explain the differences or if I have both conditions, what does this mean for me? Thank You.