Concerned about a Lifetime of On and Off Cortisone
[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:  Concerned about a Lifetime of On and Off Cortisone


I was diagnosed with late onset at 37 years.  That was 15 years ago and I have been mostly stable with good meds and a great medical team (GP, Psychiatrist, and Psychologist).  However, I am having a liver biopsy tomorrow and autoimmune hepatitus is strongly suspected.  That normally means a lifetime on and off CORTISONE.  I'm really scared about this.  My GI doesn't know much about bipolar and my Psychiatrist doesn't know much about Autoimmune Hepatitus.  How can I help facilitate a dialogue between the two?


Dear Ms. J' --

That's a tough one, as you have come to understand. Not everyone with bipolar disorder worsens on steroids, but as you have learned, it is a very substantial risk. In general, we can try to cope with that, just treating whatever symptoms emerge. Where possible, tapering on and tapering off cortisone-- as opposed to jumping in, and then later stopping suddenly -- it is probably a good idea.

Obviously we in psychiatry would want the primary care doctor, and/or specialist, to make every effort toward using alternative means of immune suppression rather than a steroid. But as you say, we in psychiatry are not well versed in autoimmune diseases, so we are not really in any position to direct treatment there. The point here: in my view the solution is not a "dialogue". Unfortunately, there just isn't that much to talk about beyond saying "don't use them, unless you absolutely have to!", at which point, if the answer is "we have to", then we in psychiatry just cope with that.

Sorry, not much to go on there. Good luck with that.

Dr. Phelps



Published May, 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?