High Energy

Since I was about 16 years old I’ve had these “spells” where it’s impossible for me to control my emotions. They come on suddenly and with absolutely no triggers whatsoever, although for hours to days before they happen I’ll sometimes have uncomfortably high levels of energy–I’ll feel either obnoxious and silly (but in a kind of desperate way, if that makes sense) or I’ll be really productive and jittery. Both of these high energy feelings are unsettling, maybe because I normally almost never have high levels of energy. The “spells,” “episodes,” whatever they are, involve extreme guilt and disgust with myself–but it’s a very visceral feeling and it’s overwhelming. I feel trapped inside my disgusting self and like I’m willing to do anything to escape it. I feel incredibly agitated and yet trapped at the same time–like I want to move or do something but I can’t. I also just feel extremely empty and sad–like, I’m filled with this overwhelming emotion but other than that I’m hollow. I feel so desperate and so unhappy and sick and like I hate myself so much–but it’s such a powerful physical feeling that it’s hard to describe with words because it’s a feeling and not a thought. I sob uncontrollably during these episodes (they usually last a few hours although they occasionally last longer) I’ve definitely been suicidal during these periods, but it’s not so much a conscious desire to kill myself than it is a need to escape how I’m feeling. I’m just afraid sometimes that since I’m not really thinking during these times that I might do something to myself–especially since I think during these times that I don’t deserve to get help or that I’m not worth disturbing people by calling them.

These episodes often happen when I have PMS, but not always–they also usually happen (but not always) when I’m experiencing a depressive episode. I’ve struggled with depression on and off for between three and four years–last year I was diagnosed with MDD and dysthymia–but these episodes seem completely different than the depressive episodes I’m used to experiencing. Is this just a part of depression? Is it something I should be concerned about? Is it indicative of another disorder? I’ve spoken to my therapist about it and she doesn’t seem worried. Any help you could offer would be really appreciated. Thanks.

Bipolar disorder is a possibility but I can’t determine a diagnosis based on a short letter. Some of your symptoms are characteristic of depression but some are not, including episodes of “high energy” during which you feel very “productive.” Those symptoms are more in line with mania which is a main characteristic of bipolar disorder. Individuals with depression do not experience symptoms of mania.

Your episodes often coincide with PMS. Another possibility, though less likely, is premenstrual dysphoric disorder (PMDD). PMDD is a more severe and debilitating form of premenstrual syndrome (PMS). If you want to explore PMDD more thoroughly, consult your gynecologist or your primary care physician. You should also discuss these possibilities with your therapist.

I would recommend that you again discuss your symptoms with your therapist. You report that she is not worried but that you are. If you are unsatisfied with her response, then consider getting a second opinion. A psychiatrist could provide that second opinion. He or she can also prescribe psychiatric medication. Medicine can help to decrease the intensity of your symptoms. I would highly recommend seeing a psychiatrist if you have not already. There are many effective medications that exist for the treatment of bipolar disorder. Don’t hesitate to seek all the help that you need. Please take care. I wish you well.

Dr. Kristina Randle