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Q: Misdiagnosed or BP Triggered by Meds?
Following a possible TIA which was followed by a neck injury, my
husband was lightheaded and started having terrible pain in his head. Since
an MRI showed nothing except the results of a level 5 concussion 14 years ago,
my husband's family told him to go to a psychiatrist since there is bi-polar
in his family. When the psychiatrist asked him if he had racing thoughts that
kept him from sleeping, my husband said "Yes" though he wasn't sure what
racing thoughts were. He lost his sleep after being on Ativan (for pain)
about a month. Also the extreme pain was keeping him from sleeping. The
psychiatrist diagnosed him as having bi-polar chemistry and prescribed Seroquel
and Depakote. He developed many neurological and problems after this
including an inability to eye-track movement, unable to read or watch t.v. He
was switched to Depakote and Zyprexa, and feels like his brain chemistry has
been completely messed up, is still in a lot of head pain, and has now
developed an incredible urge to move and restlessness of agitation. He has
become unable to feel any emotion, process or think, as become like a totally
different person. He was given Cogentin to help with the restlessness, and the
more meds he is put on, he more problems he develops, but can't get off without
terrible withdrawal and additional head-pain. He feels completely trapped and
doesn't know what to do. Is it possible that he was misdiagnosed or that
bi-polar was triggered by the heavy meds?
Dear Elaine --
Sounds like you have significant doubts about this diagnosis of bipolar
disorder, and the way in which that diagnosis was made. As you can understand,
with only your description to go on, I'm not in a position to offer a different
diagnosis or question the one that was made. Hopefully by the time you read
this, something will have been worked out leading to a better outcome. But in
case there is some value in it, here are a few thoughts based on your account.
You noted
that he "lost his sleep after being on Ativan for about a month." Ativan is the
trade name for lorazepam, an anti-anxiety medication often used in the treatment
of mood and anxiety conditions, sometimes to promote sleep. After about three
weeks of using lorazepam every day, one can develop a tolerance to it so that it
does not work as well as it did initially. In addition, at that point the body
is used to it and expects it, so that when it is not taken, a person can have
symptoms worse than the original problem, from "withdrawal" on top of the return
of the original symptoms (presuming that nothing has been done to make those
symptoms go away in the meantime). "Withdrawal" includes increased muscle
tension and anxiety, and increased difficulty sleeping.
So did
lorazepam play a role and his "losing his sleep"? Well, it might have if at
that point he stopped taking it relatively suddenly. But if he continued to
take it, then we have to look for some other explanation as to why he "lost his
sleep". And as you have probably learned, sleep is a crucial factor in bipolar
disorder. When people with a risk for this condition go without sleep, or have
markedly decreased sleep, they are much more likely to go into a manic phase. A
person with a family history of bipolar disorder, and a history of a brain
injury, could easily slip toward mania with even a few nights of sleep
deprivation.
As to
whether your husband was experiencing something like that at the time when the
doctor prescribed Seroquel and Depakote, I cannot say. Unfortunately, sometimes
these medications do indeed cause significant problems with side effects. As to
whether the bipolar disorder could have been triggered by any of these, I think
that much is very unlikely. About the only way you could explain something that
way would be taking lorazepam for a month and then stopping it suddenly. The
sleep disturbance that might cause could trigger the emergence of bipolar
symptoms.
Finally,
what should someone do when they are watching a loved one to be treated with
medications that seem to be making things worse. Well, that's a long story, as
you can imagine. The short version is to wonder out loud, in a very respectful
way, whether the medications are getting the outcome intended, and whether there
might be another way to go about things. You can get an example of the kind of
tone that I'm suggesting for this by reading my "Dear
Doctor" letter. After that, if you are in a position to do so, you could
seek a second opinion about what has happened and what might be done about it.
I hope that
something better is already happening by the time you read this letter, or if
not, that this happens soon. Good luck getting it figured out.
Dr. Phelps
Published in August, 2009
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