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Diagnosed with BPD. History of major depression, SVT. Is BPD the right diagnosis?

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Practicing since : 2006
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In November 2009 I had an episode of major depression. I had SVT and was put on a beta blocker and within a few days I was completely flat. I was diagnosed with major depression and burnout. By Mar 2010 I had recovered little so was referred to a psychiatrist and psychologist but wanted to see neither. My true belief is that I had treatment resistant depression and some anxiety. I was on occasion mildly self-harming and drinking. From what I have read, so do many depressed people. However, I was then diagnosed BPD and all of the professionals started treating me differently. They started ignoring me, restricting me, dictating to me, preventing me from discussing my mental health with my family physician. When I told them they were causing more stress and anxiety they told me to tolerate it. To cut a long story short, the service providers admitted that they made me worse but continued to treat me the same way that was causing me harm. When I complained about what it was doing to me, they ignored me more and refused to answer my questions. To be honest, the frustration due to the way I was be treated cause major changes in my behaviour. I became angry and resistant towards them. In my entire life I have never ever exhibited any BPD traits. I find it odd therefore that I could get this diagnosis at the age of 45.
I know that you are unable to give me a diagnosis, but could you possible please tell me the likelihood that I have been misdiagnosed?
Thank you,
Thu, 2 May 2013 in Mental Health
Answered by Dr. Gourav Monga 39 minutes later

Welcome to health care magic and thanks for your query.

I can understand what you are going through and I appreciate your effort to seek online support.

Main points of concern are-
- Diagnosed major depression in 2009.
- Had a history of SVT.
- Again diagnosed with BPD
- Self harming behaviour
- Taking alcohol

You are frustrated due to your treating professionals and you are resistant towards them. They made you worse than before.

Let me tell you, you could be probably having following possibilities-
1) Major Depression
2) Delusional disorder
3) Bipolar disorder

Regarding misdiagnosis as BPD-

Bipolar disorder is a mood disorder which consists of episodes of mania and depression.
Features of mania (of at least 1 week duration) are
-Increased activity or physical restlessness
-Increased talkativeness
-Distractibility or difficulty in concentration
-Decreased need for sleep
-Increased sexual energy
-Mild overspending, or other types of reckless or irresponsible behavior
-Increased sociability or overfamiliarity

Features of depression are (at least 2 weeks)-

-Depressed mood for at least 2 weeks
-Loss of interest or pleasure in activities that are normally pleasurable
-Decreased energy or increased fatigability
-Loss of confidence or self-esteem
-Excessive and inappropriate guilt
-Recurrent thoughts of death or suicide or any suicidal behavior
-Complaints or evidence of diminished ability to think or concentrate
-Change in psychomotor activity
-Sleep disturbance of any type
-Change in appetite (decrease or increase) with corresponding weight change

Onset of BPD can occur between 15-60 years of age.
Substance abuse (Alcoholism) is common in cases of BPD.
Suspicious behaviour (delusions) can occur during the course of BPD

Tell me what kind of symptoms you had from above mentioned symptoms and what treatment were you taking till now so that we can reach a probable diagnosis?

Dr. Gourav Monga
Consultant psychiatrist
Above answer was peer-reviewed by
Follow-up: Diagnosed with BPD. History of major depression, SVT. Is BPD the right diagnosis? 28 minutes later
Dear Dr Monga,

Thank you for your fast response.

I can confirm that I have experienced the following:

Mild overspending occasionally.

All of the depression symptoms.

Alcohol use as a means of calming and escape. IT was controlled use in that I only drank it in the eveining.

I am now 47 and have been on SSRIs since the age of 31 with a few gaps (6-12 months here and there without medication).
I have had about three or four episodes of major depression since age 31.

Medications I have taken:

Prozac – helped
Venlafaxine – terrible side effects and honestly made me aggressive and caused physical pain.
Citalopram – helped.
Loxalate – helped and I am currently taking that.

My honest feeling is that it is just depression (bad at times) but that I become angry or frustrated only when I am being forced into services that I feel are harmful, ineffective, or when I just want to be left alone. I don’t like feeling forced to discuss personal issues. For example, I was threatened that I would not be medicated unless I saw a therapist but that therapist was not good for me so I felt in a hopeless no win situation. Take the therapist and threats out of the situation and I start to feel calmer and have some hope.

Answered by Dr. Gourav Monga 35 minutes later

As per your description, it seems like you have probably "Major depressive disorder". Loxalate has esciatalopram which is an SSRI and a wonderful antidepressant. So continue taking it.

Regarding your aggression, there can be two possibilities-
Either it could be 1) a part of depressive pathology (agitated depression)
or it could be due to 2) drug induced switching to hypomania/mania.

What i mean to say is that one of the drug taken by you i.e. venlafaxine can cause drug induced hypomania which was responsible for your aggression (as you have also mentioned). In that case we can label it as Bipolar disorder (BPD) type III (Bipolar spectrum disorder).

I advise you to stop venlafaxine and be cautious in its future use (only in close association with a psychiatrist). SSRIs like escitalopram are not known to cause this switch usually.

Secondly, if you have problem with your therapist, you can change to another one or you can discuss all this with him in a XXXXXXX manner. But you have to keep in mind that faith is very important for a good doctor patient relationship. So, have faith in your treating doctor and continue medication as advised for an adequate duration.
Lastly, stop taking alcohol as it can aggravate your depression because alcohol is a CNS depressant.

Don't worry and relax. You will be alright soon.

Hope I have answered your query. If you have any further questions I will be happy to help.
If you do not have any clarifications, you can close the discussion, RATE THE ANSWER AND LEAVE A REVIEW. Wish you good health.

Dr. Gourav Monga
Consultant Psychiatrist

Above answer was peer-reviewed by
Follow-up: Diagnosed with BPD. History of major depression, SVT. Is BPD the right diagnosis? 11 minutes later
Dear Dr Monga,

Thank you for your help and explanations.

I should have mentioned that I no longer take the Venlafaxine and I haven't had any alcohol for many months.

I will continue with my Escitalopram.

Thank you again,

Kind regards,
Answered by Dr. Gourav Monga 30 minutes later


Kindly Accept and rate the answer with a review. Wish you luck.

Dr. Gourav Monga
Consultant Psychiatrist

Above answer was peer-reviewed by
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