Schizoaffective? How Worried Should I Be?

From Canada: About 8 years ago at age 18 I had my first depressive episode, later becoming hypomanic after using antidepressants. Two years ago I was diagnosed and medicated for Bipolar 2. From then until a month ago I was in one long depressive episode, before suddenly pulling out of it because of a medication change. Right now my mood is stable.

But something else concerns me. Several times while severely depressed I’ve heard a voice, inside my head but definitely not my own thought voice; it’s male, rough and abusive. Sometimes I am convinced it’s demonic. It hates me and tells me to kill myself.

The voice goes away when my depression is less severe, and I know it’s not all that uncommon for bipolar people to hear voices. But there are other things.

I have paranoia and delusions (the demon idea) and also hallucinations. Nothing too major: I see shadow people and movement out of the corner of my eye, hear footsteps following me, see bugs scurrying across the floor. But it seems to gradually be becoming more frequent – even now that the depression is gone. A couple weeks ago I was crouched down to straighten the bottom shelf at work when I saw a huge black dog racing at me from across the store. I shrieked and lost my balance before scrambling to my feet and realizing there was nothing there. Thankfully the store wasn’t open!

My dreams are also strange – they’re very vivid, and I’ve had an increasingly hard time differentiating them from real life. Sometimes I clearly remember conversations or events that apparently never happened.

These “psychotic” symptoms have happened since childhood but seem to be getting worse lately.

Also, since age 18 and the onset of bipolar, it feels like there’s something wrong with my brain. My memory is awful, speaking very slowly or forgetting words as I try to speak them. Sentences don’t come out right, but mixed up and unintelligible. I get “word salad” in my head when stressed.

My psychiatrist doesn’t know about any of this, except that I feel people are talking about me. I have been afraid to tell him because I didn’t want antipsychotics. Does this sound serious enough that it’s worth the risk of telling him? It doesn’t sound like just bipolar to me. But would antipsychotic meds be worse?

Thank you very much for any help you can give.

A: I understand that these symptoms are very distressing. The simple answer is “Yes!” By all means, tell your psychiatrist about what you are experiencing. We mental health providers can only be maximally helpful when our clients tell us what is going on.

I don’t know if your psychiatrist will recommend an antipsychotic medication. Do remember that a recommendation is just that — a recommendation. You don’t need to follow it. But I hope you will have an honest conversation with your doctor so you will completely understand the risks and benefits of whatever is recommended. Ultimately, it is your decision what to do.

I wish you well.
Dr. Marie

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