Q:  Girlfriend's Meds - Suggestion?

My girlfriend has bipolar disorder and has gone into a serious depressive state and currently in hospital. Her psychiatrist has her on Visken and Cipram. I have been told that Visken must be stopped if she is on her "low" phase. What is your suggestion.
 

Hello Jacob -- 
Let's see, Visken is "pindolol", a beta blocker -- derived originally as a blood pressure medication, now used to augment antidepressants because some people think it makes them work faster.  And Cipram is citalopram, an antidepressant.  So the combination makes sense if a person has a serious depression.  

If she truly has bipolar disorder, then at least here in the United States, and I think this perspective is common in other countries too, we don't generally give antidepressants without previously getting a "mood stabilizer" going.  There could be many parts of the story that I am missing, and you too; but if the story really is "bipolar disorder", and she really is on just those medications, well, let's put it this way: I think it would be okay to wonder out loud about the diagnosis and that treatment and wonder if there's some reason why with that diagnosis there is no mood stabilizer being used, and whether the antidepressant might pose some risk.  However, perhaps she's had previous episodes that responded very well to this regimen, or somebody in her family responded, or she doesn't really have a clear-cut bipolar diagnosis, or something.  In other words, don't be certain there's something wrong with this approach.  I hope her doctor is one of those who's willing to explain what the plan is and how it relates to the diagnosis, and therefore to handle your concerns.  

As for your question, as you can see it's not the Visken I'd be focusing on.  It's generally used as an augmentation agent in unipolar depression; when it was stopped would not be as great a concern in this context, to my knowledge (although it's a new strategy; I haven't used it, nor studied it closely).  

Dr. Phelps