Q:  Extremely Depressed & Anxious

My husband was diagnosed with bipolar about 3 years ago. He went from manic to now being extremely depressed. He tells me that he feels like he can not move. He has no energy what so ever. He also says that he is anxious all the time. He only takes a shower when he is made to and would not get out of bed if he wasn't made to. He is also vomiting every morning. He is currently taking 900mg of Lithium, 15 mg of Ability and the doctor just took him off 5 mg of zyprexa hoping to get back some of his energy. I am at my wits end trying to figure out what to do to help him get out of this depression. The doctor does not want to put him on a depression medicine because of the fear of sending him into a manic state.  Any suggestions would be greatly appreciated. Is it possible he is on too much medicine or not the right medicine. We have tried different ones including depakote but nothing seems to help for any longer than a week at a time.
 

Dear Kelly -- 
Make sure he has had his lithium level checked recently, with that vomiting.  While at it, make sure he's had his thyroid checked as well, since lithium can cause hypothyroidism which can produce most of these symptoms as well -- except the anxiety, most likely, the presence of which makes something as simple as low thyroid less likely, but still worth checking because it's so easy to fix. 

Unfortunately his circumstance is extremely common, though not usually so long-lasting.  In my experience the doc's who are the most phobic about using antidepressants are generally the ones who have learned the most about bipolar disorder, so that's a good sign there. But you and he and his doctor (who probably knows all these already) can look over the "nine antidepressants that aren't antidepressants" and make sure those are being used or considered. I have less confidence in aripiprazole (Abilify -- let's all boycott using that trade name, it's so smarmy) but that's mostly from less experience with it as I'm still only slowly beginning to use it much; so I don't have a feel for how that might be playing in to the current situation, for good or possibly for bad. 

I hope things improve soon, for the both of you (and his doc' too!)

Dr. Phelps

Published Sept. 2006