Donald is a 32 year-old male who is brought to your office by his wife for the evaluation of his symptoms which she has been concerned about. He no longer expresses interest or pleasure in things that used to excite him a lot. His work day starts at 9 am and ends at 5 pm. But he loses interest in the work by 11 am. Even taking breaks doesn’t give him relaxation. He is easily distracted from what he is doing. He can’t comfortably sleep through the night. He feels fatigued after doing even simple things. He feels ‘low energy’. He expresses thoughts of emptiness in his life. Just as they were planning to go to see a psychologist for counseling, she noticed some moments of ‘high energy’ in his life. He leaves for office at 6 am and ‘accomplishes a lot’ by staying till 10 pm. He rambles a lot without saying much of substance. He spends a lot of time in online gambling to the point he stops only when his wife scolds him. He defends himself stating, ‘But I don’t waste a lot of money’. These episodes last 4-5 days at a time before he returns to his usual ‘low energy’ levels. He has had five or six such ‘high energy’ episodes over the years. When you asked them “Are you hearing any voices others don’t hear?”, they replied, ‘no’. To the question, “Are you seeing any things others around you don’t see?”, they answered, “no”. To the question, “Are having any thoughts to hurt yourself or others around you?”, he answered, “no”. To the question, “Have you ever been hospitalized for any of these symptoms you’ve described?”, they answered, “no”. To the question, “Are your symptoms impacting your work negativity?”, they answered, “No, not at all. In fact, my boss gave me a raise for working late sometimes to get my projects finished before the deadlines.I’ve never felt so good before in my life.” To the question, “have you tried any medications for your symptoms?”Donald hesitated to reply, looked at his wife and then told you, “to be honest, I got some adderall pills from my sister-in-law two days ago and took them”. Then you asked him, “Did they help you?”. He replied, “No, they made my symptoms worse. My sleep and mood became worse”. In physical examination, you notice that he is wringing his hands frequently. Otherwise his physical examination is normal. What is the most likely diagnosis for Donald?
