Q. I was diagnosed with bipolar disorder II earlier this year but stopped taking medications (celexa, lithium, seroquel) when the depression lifted. I've lived with symptoms for decades now and am adapted and generally tolerant of the effects and wanted to track the moods (with the new knowledge of the cause) without drugs to confuse things. My doctor was ok about this. 

Now the depression is apparently back (after 2 months mild mania). My biggest complaints (both depression and hypomania) are self-injury, extreme irritability (everything way too loud i.e. breathing, chewing), anger and head 'noise' mostly music sometimes talking sometimes other noises, and (when depressed only) miserably negative outlook / low self-esteem, many violent visions and suicide thoughts. Also some obsessive compulsive disorder. Sometimes I feel persecuted. My therapist recently asked me to reconsider medication. What drug(s) would you recommend I try first that would have the least effects on creativity and sexual function - potentially the simplest solution (vs. a combination)? The drugs I tried before made me numb and slow- I didn't feel anything. Also is the only difference between bipolar disorder I and II the severity of the mania? I seem to 'internalize' mine and get effects inside my head.

 

  A. It sounds like you are more borderline than bipolar. Especially since you have self injury and obsessive compulsive disorder. I would use either Effexor XR (least sexual dysfunction of the meds that will help) and perhaps Provigil for lethargy/sexual dysfunction/lower creativity if it happens. I am not sure where the bipolar diagnosis comes from. Ask your doctor about it. Perhaps there is more to the story than you could put down in the small space of an email.