Is it really unipolar depression or something else?

[Helpmymumplease]

I posted this on general health but it may be better placed here. Basically just looking for any help for my lovely mum who is a complete stoic and will never knowingly advocate for herself…

She is early eighties but completely compos mentis and no signs of real intellectual decline. She is physically active normally to the point where people find it hard to believe she is as old as she is.

She has had episodes of horrible, severe depression throughout her adult life. They tend to be short but sharp, lasting 8-12 weeks before getting better. She is on duloxetine and has been for ages, has previously tried other ADs and none of them actively prevent these episodes. They’ve played around with dosage, type etc, didn’t work at all.

She’s currently in a depressive episode.

Diagnosis has always been unipolar major depressive disorder.

But both she and I wonder if something else is going on. TFT is normal, full blood count generally also comes back normal.

This current episode coincides with her being in lots of pain with her back (from osteoporosis) but previous similar episodes have not followed pain flares and appear to have absolutely no obvious physical or psychological trigger. They don’t occur in autumn/ winter only so unlikely to be SAD. The last two have happened almost to the day at the same time of year (July onset). Why would she have such rapid cycling depression that seemingly goes away on its own? I just don’t get it.

the other very odd thing is that each time before one of the depressive episodes, she experiences heightened sense of smell and then dissociation.

The smell thing is particularly odd to me.

i have wondered about all kinds of things, ranging from vitamin B deficiencies, long term Lyme Disease, and maybe even bipolar but without the extreme hypomania/religiosity/spending/boundless energy and happiness - that isn’t particularly her although she can go through phases of being very ‘busy’. I’ve just always thought this was her natural state - doesn’t like sitting around, likes to be doing/ fiddling with stuff, much like me!

Does anyone have any ideas that could help her? It’s so unfair she has to go through this and all approaches so far have failed to prevent recurrence :(

My grandmother had depression throughout her adult life and some periods of what seemed like being super busy, arranging events. I don't know all of the details as I was a child, but she was eventually diagnosed and treated for bipolar disorder. She seemed to be fine after that.

@SausageinaBun that is a definite possibility. She can be a bit like she has a motor running at certain times. It’s hard for me to distinguish whether that’s a character trait or a facet of something darker. I’m also a doer, but def not bipolar.

I just feel so frustrated for her. She’s basically been failed and left to suffer as she doesn’t really make a fuss.

I'm not a medic but could it be type 2 bipolar? They don't get the mania in quite the same way

Your poor mum though, what a horrible thing to have to suffer

@Nightmanagerfan thanks for your response. I think that is a real possibility. I’ll discuss it with her and maybe call her GP to ask her to consider this next time they meet.

i have had unipolar but am stable on meds and have been for 10 years. What my mum describes is nothing like my experience hence me thinking something else is potentially going on. It’s just so out of the blue and rapid. She will likely be completely fine in 10 weeks or so, but she is getting older and I feel she is being robbed of precious time by whatever it is she is suffering.

Would it be helpful to ask your GP for a referral for a specialist assessment/ psychiatric input?

Thank you, yes, I think that is worth pursuing @Lifelover16 . She did pay to see someone privately a few years ago but didn’t get much out of that except a different prescription :/ I think they just see a relatively uncomplaining stoic woman and just write out the next script …

I have type 2 and it was a long road to even get those answers.

I can't do "nothing" I have to occupy my mind. Sunday afternoons at home are spent cleaning, organising, ironing, ANYTHING else but to sit and ponder.

Despite a few wobbles and close calls, I have to read the signs myself and scale back to avoid a full burnout. Maybe her sense of smell is her warning signal, like a hyper vigilance because her stress levels are running high.

When I'm in a cycle I can't function, eat, talking is too much effort and I do just wish I didn't exist. I get migraines with an aura and I just shut down into a quivering mess.

Having said that, I had a former colleague in mania for years and they finished two degrees in three years - I never know it could last so long.

With therapy and playing around with medication for years they now consider me "in remission". It may be worth trialling mood stabilisers or antipsychotics alongside ADs. I was never in psychosis but the meds changed my life.

That is very interesting and very much like my mum. Even at her age she HATES sitting still and doing nothing.