OLP, a 56-year-old male fashion designer, had a very unhappy childhood, with few friends and many arguments at home. At university, he underwent a substantial change, becoming extroverted, making a lot of friends, and travelling extensively. As a professional, he was very creative, had many friends, and enjoyed going out. His father, an alcoholic who was extremely verbally abusive, committed suicide at 60 years of age. A nephew was diagnosed with depression. About 13 years ago, OLP began to isolate himself from his friends and to become very nervous whenever he was with a lot of people. He had difficulty concentrating, lost his enthusiasm for work and his creativity, and seemed to have lost his love for life. During that same period, he felt irritated and was bothered by noise, often getting into arguments with his neighbors for that reason. At work, he would also argue with colleagues, becoming angry easily and later regretting his outbursts. Since that time he has been undergoing psychotherapy and for the past eight years has undergone psychiatric treatment. He has used venlafaxine, mirtazapine, these two drugs together, and bupropion; however, there has been no remission of the depressive symptoms. After two months on bupropion (300 mg/day) and lamotrigine (100 mg/day) without any satisfactory improvement, aripiprazole (10 mg/day) was added. After five days of this combination, he developed major psychomotor agitation, accompanied by increased anxiety and restlessness, and akathisia that did not allow him to sit still for even three minutes at a time. He was sleepless at night even when taking 120 mg of flurazepam and complained of marked tiredness and muscle pain. In addition, his suicidal thoughts intensified and he experienced extreme anguish. He was given 50 mg of clozapine and all the other drugs were discontinued. After 10 days there was a significant improvement in his sleeping, allowing him to return to work. In addition, his psychomotor agitation decreased and there was a partial improvement in his feelings of anguish. Nevertheless, depressive symptoms remained: negative thoughts, extreme apathy, indisposition, and poor concentration. He was prescribed imipramine 150 mg and lithium 450 mg. He remained stable, with mild depressive symptoms after nine months. In the case of this patient, there is no clear evidence of hypomanic episodes; however, there is a report of unusual moods during his time at university. Since there are no relatives available to provide further details, the suspected diagnosis is dysthymia and double depression or type II bipolar disorder.