Concerned about an SSRI Staying in the Treatment Plan
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Q:  Concerned about an SSRI Staying in the Treatment Plan

I keep reading via those considered experts (mainly docs who have authored books on the subject)  in the area of Bipolar II, that SSRI's are contraindicated, especially long-term, yet my mother takes Lamictal, Seroquel, and Celexa.  I question the Celexa, as her history is full of negative & even life-threatening reactions/side effects to most of the long string of SSRI's that have been prescribed by 2 psychiatrists over the years.  Now she is with a new practitioner (MNHP) who seems good, but has chosen to keep her on Celexa, when rapid cycling, severe depression and suicidal thoughts have been part of her history.  I would welcome your opinion on this.   
Thank you!


Dear Rev’ --
Of course there may be reasons why people maintain the antidepressant in your mother's case that I would not understand without a thorough background. That said… 

In general, I think the majority of mood experts I read (with the exception of Gordon Parker and Jay Alexander and possibly Mark Zimmerman) are very concerned about the potential for antidepressants to make bipolar control more difficult.  That is probably the signal you are detecting in your reading. 

However, I think there is almost complete consensus that in rapid cycling and mixed states, if an antidepressant is present, one of the best ways to treat the problem is to gradually remove the antidepressant -- despite the fact that we have very little data on this issue from studies directly examining this problem.  I have summarized those data on my website, on the Antidepressant Controversies page, controversy 2.  You could present those data to the nurse practitioner with your concern.  Here are some thoughts on how to convey that concern gently and hopefully effectively, in my little essay on how to talk with doctors

The overall point is that one must proceed carefully, not assuming any particular approach is clearly correct, generating an interest in examining alternative approaches, and then working from the existing data as one chooses amongst options. As you can imagine, that goes for most of psychiatry, not just this particular question. 

Good luck with the process --

Dr. Phelps

Published July, 2008


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