Q:  Treatment Plan Questions

Dear Dr. Phelps:

I was just in to see you a couple weeks ago on the quick referral system and am now on the waiting list.  You started me on thyroid medication and started me on a plan to decrease me from using prozac (four months).  Since I couldn't really tell whether the thyroid was helping alot.  You gave me a prescription for Trileptal which I was to fill after a week if thyroid didn't seem to be helping.  I got it filled Friday and am following your schedule for slowly increasing.  

Here's my question, since if I do have Bipolar 2 we talked that prozac can actually aggravate it.  So that's why we were going to try decreasing it.

Does that mean that I won't see the effects of the Trileptal as long as the prozac is still in my system? Or will I get help from the T pretty soon.  How long should I wait to see relief in symptoms?

Aslo in reading your web page there is another drug that helps lose weight called Topiramate.  Can I take that in conjuction with the Trileptal?

How long should I take Trileptal before I see symptoms and when should I checkback with you?

OK thanks for helping me,  I appreciate you.




Dear Ms. L' -- 
Since I've actually seen you for treatment, some readers might be wondering why you'd have to write to ask, so I'll just note that I saw you for consultation and handed you back to your primary care doc' as we are forced to do in our area because of lack of psychiatrists (our group has had a waiting list for 2 years, for example).  

So this is a little weird, offering follow-up via this route.  Some of my administrators would probably freak out.  How about we have you see your primary care doc' as planned, and if she/he can't answer these questions they're welcome to call me for more input.  Sorry to not treat you like others who write here.  Medicine hasn't figured out how to handle this electronic approach (i.e. medicolegally) yet.  

Dr. Phelps