Sick for 9 Months & is Getting Worse, What do We Do?
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Q:  Sick for 9 Months & is Getting Worse, What do We Do?

My 53 year old husband was diagnosed with BP I nine months ago. At that time he was in a mixed state. Since then they have tried him on numerous meds. Before he was actually diagnosed with BP, they thought he was depressed and had prescribed Wellbutrin, Ambien (having horrible insomnia) and Klonopin (bad panic symptoms). After the BP diagnosis they added Zoloft and Tegretol to the mix. Then they got rid of the Ambien (it was expensive and gave him bad headaches every day) and added Trazadol. The tegretol made him sick so they went to Valporate Acid. It made him sick too. Oh yeah, he was on Risperdal 2mg and less (that also made him gain 40 pounds and made  him shake and seem like a zombie)  during all of this. Then they went to Lithium (900mg). This cocktail worked for a while (there were side effects, but barely bearable). Then he had a couple of days that looked like Lithium toxicity followed by two days of extreme depression, so the doc took him off of the Zoloft  , Risperdal, Lithium and Klonopin. She upped the Wellbutrin to 150 SR, added Buspar 10 mg X 2, Abilify 5mg., Lamictal started and said take Trazadone for sleep 50mg to 150mg . He hasn't slept for about a week. He is dizzy until nauseated. Today he is  having a royal panic attack to the point he thinks he might need to go to the hospital. We stopped the Wellbutrin ourselves yesterday and intend to stop the Buspar tonight. He has taken Klonopin today, just to get some relief from the panic attack. We were going to try .5 Klonopin and 50 mg Trazadone tonight for sleep. If he takes two Trazadone he is so groggy in the mornings it is miserable. Anyway, I'm thinking HELP! I don't think his doc is being systematic enough about this. Are these panic symptoms from meds or uncontrolled BP? What do we do? He is about to give up. He has been so sick for nine months and is only getting worse. He can't work hardly at all and he has his own business. This is killing us. By the way, most of   this was either stopped cold turkey (risperdal and lithium) or lowered quickly (Zoloft, Klonopin).

Dear Sí --
Sometimes we psychiatrists make very rapid medication changes when the symptoms we are chasing are severe, and the patient is not able to function because of them.  At the same time, making rapid changes sometimes leaves everyone confused: what is causing what?

It sounds like you are concerned that your husband's psychiatrist is going too fast.  At the same time, you're also concerned about the side effects he has experienced, and has continued symptoms.  His psychiatrist is probably similarly concerned. 

In general, you can start by expressing your concerns directly to the psychiatrist (she or he does not have to have a release of information to take information from you; so it is always okay to leave a voicemail message or send a letter).  You have probably already done this. It's tricky.  Many psychiatrists are so busy that taking time even to listen to voicemail is an additional stress.  Here are some thoughts on how to talk with doctors.

If this approach does not successfully resolve your concerns, and if you have the means to get a second opinion (insurance covers it; you can find one) regarding treatment options, that would be a reasonable next step.  In some circumstances even a third opinion might be useful if you can get it, until you see that there is some sort of consensus on how to proceed.  Unfortunately, many people are not in a position to try to sample the waterfront like that.  I hope that proves unnecessary.

Finally, as you may know, there is considerable controversy in psychiatry about the role of antidepressants in the treatment of bipolar disorder. If you'd like to see more information on that, I have summarized the available data -- from my point of view; there are other views on this -- on my website page entitled Antidepressant Controversies

Good luck with all that --

Dr. Phelps 

Published October, 2008


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