Is There a Way to Treat Obsessive Thoughts w/o Seroquel?
[Home] [Bipolar News] [Bipolar Disorder] [Medications] [Treatments] [Bipolar Disorder/Job/School] [Disabilities] [Ask the Doctor] [Ask David] [Self-Injury] [Personal Stories] [Graham's Column] [Steven's Column] [Storm's Column] [Columnist Archives] [Suicide] [Community Support] [Family Members] [Expressions] [Greeting Cards] [Books] [Awards] [Links & Rings] [About Us] [Contact Us]

 


Q:  Is There a Way to Treat Obsessive Thoughts w/o Seroquel?


Dear Dr. Phelps,

My 14-year-old son is bipolar, with insomnia, trouble concentrating, and obsessive thoughts of self-criticism and despair over the state of human existence.  He spent most of the summer in the hospital for suicide attempts.  Lithium and Seroquel helped with all but the concentrating.  After four months on this regime, his psychiatrist replaced the Lithium with Lamictal.  Then she cut his Seroquel from 300 mg. to 200 mg.  He felt energized and less depressed for a month, but needed Benadryl to sleep.  Then his obsessions returned.  She increased the Lamictal from 100 mg. to 150 mg.  It didn't help.  She raised the Seroquel to 250 mg. and finally back to his original 300 mg.  His sleep is broken, the obsessions are better, but he's like a zombie again.  Is there a way to treat the obsessive thoughts without Seroquel or an anti-depressant (Prozac made him hypomanic)?  One challenge is that Seroquel is the only thing that helped him sleep.  Thank you for your help.  


Dear Ms. H. --

Many patients experience that "zombie" effect on antipsychotic medications. Seroquel is not the most likely to cause this, but it certainly can. There are others that are worse in this respect.

The good news is that bipolar disorder was treated for decades without antipsychotics. Even for people whose bipolar disorder causes psychosis, they are not absolutely necessary: if one successfully treats mania, the psychosis can resolve, even without an antipsychotic. There was a classic article about this about a decade ago, comparing Haldol, an old-generation antipsychotic, with valproate (Depakote). They both treated psychotic mania equally well, and equally quickly.

Therefore, your son actually has many alternatives to replace Seroquel. The valproate would be one of the most common candidates. Unfortunately it has a very direct interaction with Lamictal such that the combination of the two can be quite tricky, though not impossible to use (if Lamictal is already in place, one must cut the dose in half, or perhaps a bit more to be ultra-cautious, then slowly bring the dose back up a bit after the addition of valproate is squared away, if some of the benefit of Lamictal was lost during the transition). Even though the interaction is tricky, some mood specialists think this is a very good combination. Valproate only very rarely makes people feel like "a zombie". By comparison, this is very common with antipsychotics.

Another alternative is carbamazepine, instead of valproate. Carbamazepine has a cousin, called oxcarbazepine, that just became generic in the United States. Unfortunately, even though it is much easier to use than carbamazepine, I do not trust it for a full mood stabilizer effect, especially if it is expected to replace Seroquel, for example.

One of the newest antipsychotics seems to cause less of this "zombie" effect, at least in some people, namely aripiprazole (Abilify). Beyond this, some of the more investigational mood stabilizers include
high-dose thyroid, which is worth looking into, at least in the long run. All of these medications have additional details linked from my main page on mood stabilizers; see the table of options.

Dr. Phelps



Published March, 2008
 

 

Bipolar World   1998, 1999, 2000, 2001, 2002, 2003, 2004, 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, 2014
Owners: 
Allie Bloom, David Schafer, M.Ed. (Blackdog)
Partners:  John Haeckel, Judith (Duff) 
Founder:  Colleen Sullivan
 

Email Us at Bipolar World

 

About Us  Add a Link  Advance Directives  Alternative Treatments  Ask the Doctor   Ask Dr. Plyler about Bipolar Disorder   Ask The Doctor/ Topic Archives  Awards  Benny the Bipolar Puppy  Bipolar Chat  Bipolar Children  Bipolar Disorder News  Bipolar Help Contract  Bipolar World Forums  Book Reviews  Bookstore  BP & Other mental Illness   Clinical Research Trials & FDA Drug Approval   Community Support   Contact Us  The Continuum of Mania and Depression   Coping   Criteria    Criteria and Diagnosis  Criteria-World Health Disabilities,  DSMV-IV   Dual Diagnosis  eGroups  Expressions (Poetry, Inspiration, Humor, Art Gallery, Memorials  Family Members   Getting Help for a Loved One who Refuses Treatment  Greeting Cards  History of Mental Illness  Indigo  Job and School  Links  Manage Your Medications  Medications   Medication and Weight Gain    News of the Day  Parent Chat  Pay for Meds  Personal Stories  Self Help  Self Injury  Significant Others  Stigma and Mental Health Law  Storm's Column  Suicide!!!  The Suicide Wall  Table of Contents   Treatments  Treatment Compliance  US Disability  Veteran's Chat  What's New?