Sometimes I wish that my depressed patients had more impatience. Eagerness for change when you have been depressed for a long time can be a good thing.

But if you have bipolar depression, impatience is not always a useful emotion.

This past week, several people began expressing impatience with their progress.

A couple of them expressed the view that I was unfeeling because I seemed not to care about their continued struggle with depression, when I suggested that we proceed with caution about making changes.

“I have been depressed for a year, don’t you care?”

Several features of this increasing impatience have me concerned.

For one thing, in all of these patients, the increased frustration began after they started to see a significant improvement in depression symptoms.

The greater the improvement, the more impatient they became. And the less willing they were to accept my recommendations.

In fact it couple of them shared with me this week that they had felt so impatient that they decided they needed to start making changes in their medication regimen faster than I was comfortable doing.

One of the hard things about psychiatry is dealing with a situation where my best advice is not what the person wants to hear.

And I know that rapid changes out of depression, for people with bipolar depression, can trigger a shift into hypomania or even mania.

Since I started writing this post four days ago, one of the three people with escalating impatience who inspired this post has switched into mania…

So, be careful about increasing impatience. Look back on the recent past and consider whether you are moving in a positive direction with your depression, or not.

Enduring change often takes place slowly, and dramatic changes may not always be a good thing.