Would Like Son's Meds Changed - Possibilities?
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Q:  Would Like Son's Meds Changed - Possibilities?

My son is diagnosed bipolar 2 and is currently on effexor and abilify.   We have diabetes in the family, and my son is morbidly obese.  In addition, while he has been relatively stable until recently, he's been very depressed lately and the meds don't seem to be working.  By the way, I've had him on DHA for years, and it is  at least as effective as the pharmaceuticals.  I want to ask his dr. to change his meds...what do you suggest I research as possibilities?  Thanks.

Dear Pat --

1. Step one: there is a possibility that the Effexor is not only not working, which is clear, but is contributing to "cycling", which could be the basis for the recent depression. Therefore one option to be discussed with his psychiatrist is whether slowly tapering Effexor should be part of the next set of medication changes. This is controversial. His psychiatrist might not agree. Some of the data relevant to this suggestion can be found on my page about
Antidepressant Controversies: see the second controversy about mood destabilization

2. After that, obviously one would be looking for a "mood stabilizer", preferably one with antidepressant effects. See the
Mood Stabilizer Options summary page for a list of current medications listed by the quality of the evidence supporting their use. In the state of Texas, the algorithm -- a recommended menu, and a recommended order in which to choose from that menu -- begins with lamotrigine (Lamictal). High on that list are quetiapine (Seroquel) and lithium. You will find on the mood stabilizer page some information about aripiprazole (Abilify) showing that it too has some antidepressant effects, although technically the data supporting its use in bipolar depression are not quite as good as has been shown for some other options.

You'll also see DHA (one component of fish oil) listed under the heading of "randomized trials positive". In my experience, with the exception of one possible patient, it has not been as effective as pharmaceuticals (by contrast, however, several other non-medication modalities have been: light therapy in particular, and exercise, and psychotherapy).

Good luck with the research.

Dr. Phelps

Published January, 2008


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