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Treatment options: strange case



New member
May 2, 2018
Hello all,

I was wondering if anyone had any ideas or experience in regards to treatment options for the below. I don't quite know what it is.

Symptoms started acutely at 19. There is a clear cycle and there are two phases to this cycle: A and B.

Phase A is normal, or with marked reduced severity of the symptoms in phase B. Phase A and B alternate, roughly 2-3 months in each. Onset and abatement is acutely sudden (that is, the switch is rapid, not insidious).

Phase B consists of oversleeping (I can't get rested no matter how long the sleep, ie I wake up very tired feeling like I need more sleep, poor quality sleep (difficultly going to sleep, early morning waking and intense over-dreaming), fatigue during the day, reduced motivation to do general tasks and, more alarmingly, expend mental effort or energy (causing difficulties with work), impaired concentration (on work, reading, chores - whatever), mild or moderate anhedonia, desire to sleep excessively, a compulsion to overeat and binge (I can gain a lot of weight in this phase) and weighed-dowm limbs (my eyes even feel less comfortable when open). Mood can be variable in this phase, in that it can very briefly lift, but will drop soon back into this phase until the cycle has come to an end. I can tell when the cycle is abating. There is significant increase in anxiety symptoms during this phase. Severity: alternates between sub-threshold, mild and moderate (self-assessment). There is no sadness, emptiness, guilt or grievances of any sort. In fact, my life is pretty OK. I have a good job and friends, etc. The issue is these symptoms are bothersome. Acutely I manage to function, but I think the long-term burden is quite high - missed opportunities, reduced quality of life, etc.

Triggers: none. The phases cycle regardless of what is happening. Overall I am not unhappy - no history of trauma, abuse or anything like this. These cycle symptoms reduce my life quality significantly, however.

Family history: mother - psychotic depression/mixed mood. Takes lithium and Abilify(former: Risperdal) along with an AD.

Prior treatment: at 20 a course of CBT (no effect). At 28 a prescription for Quetiapine 100mg/day (Seroquel IR) to act as a mood stabiliser. I opted not to pursue this due to the weight gain associated with second-generation APs. That's it - over 10 years of mood cycling. Probably 50-100 phase Bs, whatever you want to call this.

Hypomanic history: none. Nothing obvious. No reduced need for sleep.

I have not been diagnosed with the term "depression", I believe on account of severity. Given what I have seen of major depression, I do not believe that I meet this criteria, outside of fleeting or brief periods - certainly not sustained. What I experience is much more chronic, however, as I would estimate that 50% of the time I experience sub-threshold symptoms which impair functioning, just not to a severe degree.

Does anyone have any ideas or suggestions for a way forward given I do not wish to take an AP? Moreover, does anyone have any experience of anything similar to the above? It seems very unusual. I wonder if I have a problem with the nervous system or my circadian clock since long-haul travel through timezones seems to precipitate an onset of a higher severity and more enduring phase B (two instances).

Thanks all!
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:welcome: to the forum. Sorry I can't read your whole post as my depression and sever anxiety are making it hard for me to concentrate. I just had to welcome you though. :hug:


Well-known member
Jun 8, 2016
The thing that came to mind while reading this was Cyclothymia, whether that is what's happening though only a doc can tell you. The thing that would go against that is perhaps the fact that you don't mention any upward shift in mood, only a mood change between okay and something akin to a sluggishness. One thing I would say on that though, is that we aren't always the best judges of our own states. Being an illness of the mind, in whichever fashion, means that what we think is happening can sometimes be very different to what is actually happening, and we can be convinced that we are, or aren't, a certain way, when others would maybe say otherwise.
You say your mood goes back to a state of normality as phase A, but are you 100% certain that you are acting 'normally' during that time? Could you perhaps speak to some people about how they see you? It's possible that you are somewhat 'up' but aren't aware of it. Similarly, when you are in phase B, would others say that these are more like mini-spells of depression, only not all that severe?

If you feel that something is going on and you want answers you have to push for things to get looked at. My own experience with mental health and diagnoses has been long and drawn out and terrible, and I'd probably still only be treated for depression if I didn't grab the bull by the horns and make a very firm (but fair) request for something to be done (meaning being sent for a proper assessment). From there you can know what might be going on and what help is available. GP's are often happy to just dish out the pills and not go any further; it's your life, if you want to take control of it, there is your first step.