Questions for a Change

Looking for a career change, a move or a boost in your lifestyle? Here is some questions that may help you decide the direction your life will take: 

• What three activities are most important to you? 
• What three activities give you the most enjoyment? 
• What three values would you want to be written on your tombstone? 
• What three things would you like to be remembered for? 
• What three ways do you want to help others? 
• What three things do you wish for your family? 
• What three things do you want for your husband, wife or significant other? 
• What three ways do you want to serve God? 
• In what three ways can you please God?
• What three financial goals do you have?
• What do you want to accomplish in the next five years?
• If you had an unlimited capacity to choose any profession to pursue what would it be?
• Write down three self improvement goals

Write those dreams down and begin following a plan to achieve them.

Henry David Thoreau wrote, If one marches confidently in the direction of his dreams and endeavors to lead the life he has imagined, he will meet with success unexpected in common hours.

Bipolar Spectrum Disorder

Five or more of the following marks a Depressive Disorder: 

• Depressed mood—feeling low, sad or, as Shakespeare wrote, feeling life is dull, stale, flat and unprofitable. 
• Loss of pleasure in usual activities. 
• Weight or appetite changes. 
•  Change in sleep patterns. 
• Psychomotor retardation—slow movements, halting speech, just dragging around. 
• Fatigue, loss of energy. 
• Feelings of worthlessness or guilt 
• “Brain fog”—difficulty thinking, concentrating or forming thoughts, forgetfulness, trouble concentrating, indecisiveness, cloudy thinking. 
• Suicidal impulses. 

Two recent international studies involving over 8,000 patients are consistent with other estimates showing that almost 50% of depressed patients fall into the bipolar spectrum category. Bipolar Spectrum Disorder includes the following diagnostic categories:

• Bipolar I and Bipolar II Disorder characterized by mood swings alternating between normal mood, manic or hypomanic mood and depressed mood are found in 16% of depressed patients. 
• Bipolar I patients have one or more manic episodes that are so severe that hospitalization is almost always required for treatment. Mania is marked by at least three of the following symptoms: 
• Unrealistic, grandiose beliefs about one’s abilities or powers. 
• Rapid speech that makes it difficult for others to keep up. 
• Acting recklessly without thinking about the consequences. 
• Racing thoughts, jumping quickly from one idea to the next. 
• Distractibility marked by poor concentration and attention. 
• Impulsiveness, poor judgment, agitation 
• Sleeping very little but without loss of energy. 
• Extreme irritability or euphoric mood.
• Bipolar II patients have three or more of the same symptoms, as those with Bipolar I Disorder but the symptoms are not as severe and don’t last as long. These symptoms are called hypomanic (hypo = below). 
• A hypomanic episode is only required to persist for four days instead of seven as with a manic episode.
• Those in a hypomanic state can make bad decisions that harm relationships, careers and reputations, but they are able to perform without losing touch with reality, and they don't require hospitalization. 
• Antidepressant induced mania—depressed patients who become manic or hypomanic when taking an antidepressant. 
• Depression with mixed features is characterized by at least three of the following symptoms: 
• Elevated mood or a labile mood (rapid changes in mood). 
• Uncomfortable elevated energy makes one feel wired, restless or gives a sensation of feeling like “I'm crawling out of my skin.” 
• Impulsivity that often has a reckless tone such as quitting relationships or jobs, breaking things, aggressive driving or self-harm. 
• Patients may attempt to relieve depression by over spending, binge eating, drug addiction or watching pornography. 
• Unbearable anxiety—“Everything gets on my nerves. I’m tired and depressed in the day, then wired at night.” 
• Increased confidence such as demanding or intimidating behavior, or absolute certainty of beliefs. 
• Ruminating thoughts crowded with depressive or anxious feelings. 
• Rapid speech associated with dramatic expressions of suffering.  

Treatment of depression with mixed features:

• Antipsychotics for acute episodes such as aripiprazole (Abilify), risperidone (Risperdal) or lurasidone (Latuda). I prefer Abilify 5-15 mg daily because it is the most studied antipsychotic for this condition. 
• For maintenance therapy lamotrigine (Lamictal) 50-200 mg daily or lithium to keep serum levels 0.4-0.6 mEq/L for depression; 0.8-1.2 mEq/L for mania.