Q:  Meds & Has Insurance for One Month

I'm 45, registered nurse, was diagnosed 3 years ago with Bipolar I. I've been on lithium, Seroquel, Lamytcal, Respirodol, Cogentin Depakote 2500ER. I have extreme fatigue, poor focus, distracted, weight gain, anxiety, and underlying depression even during rapid cycling, and BPD. what to you suggest. I have not been on meds for a month due to not having money and insurance, but I now have insurance for one month, and appt. with a Doc.. I'm isolated with little support system. My work and dog is all I have.


Dear Ms. H. --

I'm glad you have work, and your dog.  Let's see: insurance for one month.  That's not enough to rely on for a long-term plan, obviously.  So the plan probably ought to be based on medications that you can afford, which means generics (because if you went on a patient assistance program from a pharmaceutical company, they would try to drop you every time you got insurance; although if you were very careful about the timing, you might be able to get enrolled, and not have to reenroll until the next time you were uninsured.  This is important, because Seroquel is not going to be generic for a long time, so that was a really effective agent for you, getting a patient assistance program going for that one might be worth considering.  The paperwork is intimidating sometimes but not impossible.  Certainly not as bad as taxes!)

If you are really not taking any medications now (or by the time you read this reply), then you are in a position to rebuild the program very carefully, starting with the medications that historically worked the very best.  In a collection that you describe, there is only one which is not widely regarded as a central player, that's risperidone.  And that is the one which made you need Cogentin.  So if presented just with that list, and knowing nothing else about you, that would be pretty low among my priorities.  All the rest makes sense, although the dose of Depakote is unusually high, so that some point -- like when you have insurance -- you might want to try to get a Depakote blood level (valproate level).  It might tell you whether you are a "rapid metabolizer" who needs high doses of many medications to get a standard blood level; or at least provide a hint about that.

The good news is that all the rest of the medications you listed here are now available as generics.  Lamotrigine (generic Lamictal) and divalproex (generic Depakote) recently joined this list, and their prices are slowly falling.

I hope something in these ideas proves to be useful to you.  Good luck getting this worked out.

Dr. Phelps

Published June, 2009