Q:  Prozac & Anxiety

I'm concerned about the antidepressant issue and bipolar. If my husbands Dx is correct he has Bipolar II w/PTSDw/substance abuse issues. Clean and sober approx. 90 days.  He is currently on Prozac 40mg, 1350mg Lithium, just stopped Abilify (he fell asleep driving), back on Risperdol starting at 1mg, Cogentin 1mg BID (which he quit taking because of the label suggesting drowsiness and is now having urinary incontinence again), Clonazepam 1mg TID, however, Tom was only taking .5mg BID and just recently quit taking that because of the drowsiness and is starting to exhibit the anxiety again.  How do we get off of this medication roller coaster?  Also, we are interested in a consultation without insulting his current doctor.  Any suggestions would be appreciated.  Thank you for your time and your interest in helping these people with these terrible brain disorders. 
 

Dear Ms. S' -- 
Sounds like we could put your question thusly:  "is it possible that the Prozac is causing this anxiety that is making some of these other medications necessary?"  Answer: yes.  Is it likely?  Can't be sure.  Would I consider tapering the Prozac to try and figure out if it was contributing to the problem?  Yes, because even if things were going pretty well that would be something to consider -- as Dr. Ghaemi of Harvard recently stated in his summary, in an issue of the journal Bipolar Disorder that was devoted to this antidepressant controversy (the link is my summary on that topic, including links to some of the articles in that issue). 

How can you raise this issue without insulting his current doctor?  Here are some thoughts on talking with doctors.  Good luck with that. 

Dr. Phelps

Published May, 2004