[19M] Struggling with mood swings, substance use, and self-harm

Patient Description

A 19-year-old male reports long-standing feelings of depression, characterized by hopelessness and a sense of worthlessness, which have been present since 2019. The patient describes periods of elevated mood, energy, and sociability, lasting a few weeks, which interrupt his depressive episodes. These mood swings have led him to question his mental health status further. The patient has been using weed to alleviate depressive symptoms but experiences withdrawal symptoms when not using. To counteract the sedative effects of weed and to enhance productivity, the patient also uses Adderall. However, this has led to a cycle of substance use that affects his sleep, with difficulties falling asleep until the early morning hours. The patient has a history of self-harm during periods of panic, which are associated with intense negative emotions and anxiety. He has been prescribed Bupropion 150mg daily but reports no significant improvement in his depressive symptoms. The patient expresses significant social anxiety, feeling out of place in social situations, and experiences rapid and intense emotional attachments that contribute to his distress. His academic and personal responsibilities are severely impacted by his mental health struggles, including an inability to concentrate, fulfill responsibilities, or care for himself properly. The patient's current medication regimen includes Bupropion 150mg daily, with no other over-the-counter medications, vitamins, or supplements reported.

Arora's Assessment

What might be happening

Based on the information you've provided, possible diagnoses include:

Major Depressive Disorder (MDD): This is characterized by persistent feelings of sadness, hopelessness, and a lack of interest or pleasure in activities. It can also result in physical symptoms, such as changes in appetite and sleep. Your report of feeling depressed most of the time, having difficulty sleeping, and experiencing significant weight loss may be indicative of MDD.
- Treatment typically involves psychotherapy (talk therapy), medications like antidepressants, or a combination of both.
Bipolar Disorder: This condition is characterized by periods of depression and periods of mania (feeling extremely energetic and social). Your description of having weeks of feeling extremely energetic and social interrupting your usual depressive state could be indicative of the manic episodes seen in bipolar disorder.
- Treatment often involves medications to stabilize mood and psychotherapy.
Attention Deficit Hyperactivity Disorder (ADHD): This is characterized by persistent patterns of inattention (difficulty concentrating, being easily distracted) or hyperactivity-impulsivity (being fidgety/restless, interrupting or intruding on others). Your report of lifelong difficulty concentrating and impulsively using Adderall could be indicative of ADHD.
- Treatment usually involves medication, psychotherapy, or a combination of both.
Autism Spectrum Disorder (ASD): This is a developmental disorder that affects communication and behavior. It can involve difficulty with social skills, repetitive behaviors, and strong interests in specific topics. Your report of feeling socially awkward and falling in love quickly could potentially be indicative of ASD, but a thorough evaluation by a healthcare professional is necessary to make this determination.
- Treatment often involves behavioral therapy, and sometimes medications to manage associated conditions like ADHD or anxiety.
Substance Use Disorder: This is characterized by the misuse of substances despite harmful consequences. Your report of using weed and Adderall to manage your symptoms, experiencing withdrawal symptoms when not high, and not following the prescribed dosage for Adderall may be indicative of a substance use disorder.
- Treatment typically involves a combination of medications, counseling, and self-help groups.

Please note that these are potential diagnoses based on the symptoms you've reported. A healthcare professional can provide a formal diagnosis after a thorough evaluation.

What you can do

Seek help from a healthcare professional: Given the severity of your symptoms and their impact on your daily life, it's important to seek help from a healthcare professional. They can provide a thorough evaluation, make a formal diagnosis, and develop a treatment plan tailored to your needs.
Reach out to a trusted person in your life: Share your feelings and experiences with someone you trust. They can provide emotional support and help you navigate the process of seeking professional help.
Practice self-care: Try to maintain a regular sleep schedule, eat a balanced diet, engage in physical activity, and take time each day to relax and do things you enjoy.
Avoid self-medicating: Using substances like weed and Adderall to manage your symptoms can lead to more harm than good. It's important to use medications as prescribed by a healthcare professional.

What you should look out for

If your symptoms worsen or you start to have thoughts of suicide, seek immediate help. You can call the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255) or use the Crisis Text Line by texting HOME to 741741.
If you notice any new symptoms, such as hallucinations (seeing or hearing things that aren't there), delusions (strongly held false beliefs), or severe mood swings, seek medical attention.

Remember, it's important to seek help from a healthcare professional for a formal diagnosis and treatment.

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9 mo ago

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