Treatment Plan & Self-injures
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Q:  Treatment Plan & Self-injures

Hello Dr. Phelps,

My question concerns my 80 year old mother who was diagnosed bipolar at UTMB Galveston in 1968.  She also had electric shock treatments.  She has been taking 600 mg. Lithium daily ever since. She is under the care of psychiatrist who has prescribed Risperal .75 mg daily in addition to the Lithium for tremors and obsessive thoughts. Her Lithium level is .7 mg.

She also suffers from self-injury by scratching her head and face, making herself bleed a little for hours at a time.  She has been doing this since 10 years old. She can stop herself when she becomes busy doing something like shopping or eating out.  I never knew the magnitude of her problem until I started helping her out at home with medications, meals and bathing. She could always hide this problem when I was younger living at home.

Do you think she would benefit from Omega 3 supplementation or T3/T4?  She has all  the symptoms of hypothyroidism, however her TSH is .681 mg. I'm just hoping to help settle her down in her last years here so she has some peace of mind.

Thank you for your time!  I have really learned a lot from your website.  God bless you!


Dear Ms. M' --
You could ask the Galveston team to comment. Dr. Hirschfeld in that department is quite famous re: bipolar disorder expertise. My thoughts: omega-3's have significant antidepressant effects, so you'd have to watch out to make sure they didn't seem to be making things worse (the target you describe is not really depression, it sounds like; this kind of agitation/self-harm is very commonly made worse by antidepressants). Similarly, adding thyroid could be considered for "rapid cycling" or depressive symptoms, and it too could make the agitation side of things worse. The treatment she's on so far is very logical, standard; but I wonder what the team would do if you emphasized this self-harm? I think they'd consider adding something or switching; there are numerous alternatives, e.g. swapping lithium to Depakote (with a cautious cross-over phase of both, probably); or swapping Risperidone to Zyprexa. Both Depakote and Zyprexa are also very standard approaches, as you've learned, so this is not anything radical -- just what might evolve with an emphasis on this new (additional) target. Good luck with that.

Dr. Phelps

Published August, 2004


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