Q:  Bipolar Disorder & Narcotic Meds

Dear Dr. Phelps,

I was diagnosed with Bipolar II, chronic depression and anxiety disorder about 6 years ago. I have been feeling bad for about 15 years, but finally it got so bad I had to seek professional help. I seem not to respond to any medications. I have been through every SSRI, Lithium, Depakote, all their cousins, the older antidepressant
(anafranil, imiprimine and so on), most anti-seizure medications (possibly all of them) and many "cocktails". (combination of meds) I still feel depressed, moody and anxious. I have had my thyroid and hormone levels checked and all are normal. I have read where some patients have been put on methadone or percocet as a last resort. I would love to try this as a last resort, but can not seem to find a doctor willing to prescribe these medications for this condition. I know they are addictive, but I have read where they make a world of difference when nothing else works. Am I wrong to want to try this. I would rather shorten my life and live a little h!appier than to live a long miserable life. I am 45 years old and know the condition will probably get worse. Any advise you have would be grateful. Thanks.
 

Dear Ms. Crystal  (or Mr. Crystal; but I'd be surprised if that were the case) -- 
You may have been through just about everything, but only a few patients of mine have ever reached that point.  There is almost always something to try -- e.g. lamotrigine augmented with lithium, plus Klonopin for anxiety and a little bit of Risperidone for a little more antidepressant effect and to suppress any manic pressure from the lamotrigine.  Creating those kind of mixtures, it's pretty hard to "try everything". 

As you've learned, it is not "standard of care" to prescribe narcotic medications for this condition.  You are just not going to find a reputable doc' to do that.  You might find somebody, but I'd worry about who you were working with.  Before you go there, I'd even have you look at things like ECT and TrueHope.com.  Ah yes, and I'd be very surprised if you've had verapamil (from the current list of "mood stabilizers").  There's just about always something to try within what's more "standard" in the profession; thus my little essay on hope.  

Dr. Phelps


Published September, 2002