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Q: Given My History with Colitis and IBS Should I be Looking Into
Alternatives?
Dear Dr. Phelps,
I was finally correctly diagnosed as BP2 a couple of years ago at age 35 when I
was put on Cymbalta to deal with one of my many recurring depressions. I pretty
much went "crazy" on it and my GP sent me to a psychiatrist to get me sorted
out. It was determined that I was probably early onset based on my mother's
descriptions of my behavior as a child and the cycles that became apparent once
my life story was on paper.
I am on Tegretol 200mg x 2, Lamictal 50 mg x 1, Wellbutrin 300mg x 1. I have
tried Geodon, Abilify, Seroquel and numerous other head meds with various side
effects that drove me off of them. (But not Depakote or Lithium due to my weight
and concerns of toxicity.) I am also currently taking Lipitor for cholesterol,
and waiting to see if I can try another high blood pressure med as
Hydrochlorthiazide was a bust. I am very obese, and I am sure losing weight
would help with the blood pressure but I'm not doing well with that. (I was
bulimic as a teen and am still a binge eater. I occasionally was close to
anorexic when I was manic.) I've also had ulcerative colitis since childhood,
although since having my kids it's more like IBS.
My type of bipolar is a baseline of completely apathetic unless it concerns a
pleasurable activity that I am interested in, in which case I binge on it to the
expense of everything else. So I can sleep all day and ignore my housework, but
somehow find the energy to stay up all night watching TV or surfing the
internet. I dip into serious clinical depression every couple of years, and have
some problems with mania and hypomania. My angry episodes can be very scary, and
I always regret afterwards how much I scream at my family.
My current drug cocktail is is working in that my symptoms are reigned in
somewhat. A lot less pressured speech and the ruminating and suicidal thoughts
that go along with it are much better. But the distractibility and brain
function are definitely worse. I miss feeling sharp when I am manic. And as I
said I am really apathetic, which is another thing I miss about mania. It's the
only time I can do my housework or writing without feeling like it is a chore or
turn away from food when I've had enough. In fact, I think the only times I have
been thin since puberty were during my manic phases.
Someone recently pointed me to this website
http://alt-therapies4bipolar.info/ortho.html which concerns itself with how the
intestines can play a part in mental illness. Given my history with colitis and
IBS should I be looking into alternatives as suggested there? [sentence deleted
at writer’s request]
Sorry for taking the long way around to my question. I wasn't sure what
information about me would be pertinent.
Thank you for your time.
Dear Anon
--
Well, that was interesting, touring around the website you linked. One of the
pages on that site describes
why psychiatry ought to be banned, offering 25 separate reasons, including
that we masterminded the murders of hundreds of thousands during the Holocaust;
that we are racist, ageist and homophobic (particularly we white males); sexist,
fascist and routinely fraudulent and coercive. How flattering, to get this level
of attention.
(Readers of
Bipolar World who have had better experiences with psychiatrists might consider
a very respectful and restrained response to Mr. Darman – but cautious, with no
great hopes of a change in his site or beliefs, and being prepared for a very
emotional reply from him. His email address is at the bottom of his
homepage, if I am reading it right.)
Mr.
Darman’s webpage is a very good example of why we all need to ask “who says?
what’s the evidence?” for any proposed treatment. After all, anyone can write
about their ideas and their experience. Why should you trust one source over
another? Because they write well? (or, as in Mr. Darman’s case, write
prolifically?) Because they cite numerous authors, and explain why those authors
should be trusted?
This is why my own website about Bipolar II
begins “Don’t believe what you read here. Really. Be as skeptical as you
want” and goes on to explain (briefly) what a randomized trial is We have to
have some standard by which to judge whom to believe.
As for your situation, there is some sort of connection between inflammatory
bowel disease (e.g. ulcerative colitis) and bipolar disorder: they occur
together more often than their statistical frequencies would predict. Indeed,
searching
PUB MED (National Library of Medicine) for a reference I might cite on that
(here
it is), using the search terms in inflammatory bowel bipolar disorder,
the first reference is an
article in which lithium was used (in rats, not in humans yet) as a
treatment for an artificially induced inflammatory bowel problem (those poor
little animals). It did show some value, but that of course is not a basis for
running off to your doctor to see if she/he might be willing to give you
lithium. (On the other hand, lithium is an obvious candidate to consider to
address the apathy/low motivation state. As is something to talk about with
your doctor, if you have not tried it yet).
While you’re at it, wonder as well about whether you might see further
benefit from increasing lamotrigine, which is often used at higher doses such as
200 mg, and where the highest routine dose is 400 mg. Lamotrigine can have more
powerful antidepressant effects as the dose goes up – but don’t do this on your
own, of course. The risk of the dangerous skin reaction this medication can
cause goes up again every time you move the dose up, though it goes back down to
where it is now, roughly, after those increases. In other words, the rash risk
is not directly related to the total dose, only to phases of moving the dose
upward.
The same story applies to carbamazepine (higher doses can work better,
standard “top end” is 1200 mg or going by blood levels), although it may not be
as likely to address the apathy, and might even make that worse. Finally, if
your mood/energy are still clearly cycling up and down, you should talk with
your psychiatrist about whether the appropriate (Wellbutrin) might be playing a
role in driving that cycling and should at some point be tapered off. I hope it
is clear that these are very complicated maneuvers and should only be done in
consultation with your psychiatrist.
Thank you for the interesting reference to Mr. Darman's site. Always good to
know how we are being presented out there, we psychiatrists. (Yipes!)
Dr. Phelps
Published in August, 2009
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