Maggie asks…

I’ve messed up my meds by going cold turkey due to difficulties with insurance and lack of funds. Now I have to wait for the mail order prescription and I have not had any lithium for a month. This week I started noticing some of my early signs of my hypomania returning. Tonight, I’m not sleeping.

I don’t have a psychiatrist right now since my insurance wouldn’t cover his $300 office visits. I’ve just started with a new primary MD.

What are my options until I get the meds and get them to a therapeutic level? I really want to sleep! I start struggling with anxiety, agitation, and irritability that can escalate to rage. I’m more than a little nervous at this stage. Can you advise?

Dr. Fink answers…

Your best option at this point may be to contact your primary care physician and explain your situation. Your doctor may be able to provide you with samples or a short-term prescription you can have filled at your local pharmacy to carry you through until your mail-order prescription arrives along with something for the short term to help you sleep.

Maggie asks…

My 21-year-old was diagnosed with Bipolar I after an extreme manic episode (he was hospitalized). It was a long and difficult few months (awful treatment, bouncing around to different doctors, etc.) during which his mania tapered down, and then turned into a deep black depression, which he is out of now.

No one can persuade him to take medication. Now that he’s feeling normal again, he seems to think that he doesn’t need medication. So no meds, no therapy, no treatment of any kind. And I am quite sure he’s self-medicating with “other” substances. (He lives with us – me/mom, younger brother, step-father.)

Advice?

Dr. Fink answers…

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Gwen writes…

My son was diagnosed with bipolar disorder in the 5th grade. He is now about to turn 21. He cuts and he cannot hold a job or finish a class at the local community college.

His bipolar disorder seems to be more depression-based than manic, or maybe the lithium and Abilify he takes helps the mania but doesn’t treat the depression.

Are there any medications recently developed which can help the depression? I know there is a study underway looking at this problem, but I can’t find out much about it. Sam took the initial test and they said that he qualified, but is no longer interested in participating in the research.

Cathi asks…

My friend’s 9 year old has had severe behavioral problems and several alternating diagnoses. The Dr. has prescribed Focalin, Trileptal, Lamictal, and Seroquel. She has no concentration, violent outbursts, hallucinations, etc. She has been diagnosed, at present, with ADHD, Bipolar, ODD, and PDD. She will not do work at school; instead, she sits and picks at her skin. She has been violent and tried to choke other individuals. Mam says she can’t even leave the house with her.

My friend has no money. The state has removed an older child due to DMH reasons. She is afraid of the state agencies, but has nowhere to turn. Court appointed attorney said to call if she won the lottery. What happens to these children? These medications seem excessive and risky considering her age, the possibility of adverse interaction, and off label usage. Any advice or help. We are desperate. Thank you.

Dr. Fink answers…

This is an all too common situation in children with multiple levels of developmental, emotional , and behavioral symptoms, especially when the family’s resources are limited. The first place to start is with the current doctor to get a clearer picture of the reasons for the current medications and to express clearly the ongoing symptoms that are not being addressed.

Chris asks…

Can long term (decade+) acute pain from an artery joining a vein directly in the spine that causes legs to not work very well lead to bipolar? Person has master degree in Mech Engineering and a MBA. Started to make poorer decisions which led to job loss, went on disability, divorce, severe ruminating, depression, possible suicidal thoughts, inability to think things through, sense of being lost and blaming one’s self for all that has gone wrong, fear or what is going to happen and impulsive behavior that cost his life savings.

He knew what to do but didn’t do it to prevent such a large loss of savings. He is seeing a therapist for mental health reasons and a regular doctor for his physical impairments. A lot of his symptoms I’ve seen in several bipolar individuals who I am familiar with. He asked me if he could be bipolar. Therapist thinks pain.

Dr. Fink Answers…

Kelly Asks…

About a month ago, I was taken off my Lamictal, lithium, Seroquel, and Zoloft. I have a new Dr. who has prescribed me 150mg of Wellbutrin SR and 600mg of Neurontin. I became very depressed, had sleeping problems, and then as the third week hit, I became suicidal.

She increased my Wellbutrin SR to 150 mg twice a day and Neurontin up to 900mg (300mg morning and 600mg in the evening). I feel she is not treating me for my rapid-cycling Bipolar. I am either up or real real down, more down moments than my manic high, which often occurs.

Is she helping me or going to hurt me? I do not want to visit any more hospitals as a result of a doctor not giving me the right doses or too little or, as it is now, I have no antipsychotic meds, which is worrying me. Is this why I feel so depressed and suicidal thinking?

Please help. I am 43. I am not a child with Bipolar. Is this weak for my case? I have been hospitalized twice with Bipolar and I really wish to stay out of them. HELP PLEASE!!!!

Dr. Fink Answers…

Hi, Kelly. I am so sorry to hear that you are struggling like this right now. Most importantly, you should continue to express to your new doctor how badly you are feeling and insist that she explain to you what she is doing and why.

Kim Asks…

Is there a way to combat the headaches and joint pains when taking the lithium?

Dr. Fink Answers…

Hi, Kim. Good question. Most importantly discuss these side effects with your doctor immediately. Your doctor may want to run a blood test to determine your lithium level and make sure your lithium level is not toxic. Headaches can indicate toxicity. Headaches may also be a sign of dehydration, which can occur with lithium, so keeping hydrated is important.

In Wednesday’s post, “Childhood Trauma Linked to Psychosis: Maybe Not,” I introduced a few terms and concepts that many people seem to wrestle with. In this post, I try to clarify the terminology and explain some of the concepts related to psychosis, hallucinations, and delusions.

Psychosis

Psychosis is defined as an abnormality of thoughts (content) or thinking (process). Psychosis is not a diagnosis in itself but a type of psychiatric symptom that occurs in a variety of diagnoses, including schizophrenia and bipolar disorder.

Schizophrenia is primarily a disorder of thinking – psychotic symptoms are the main presenting symptoms. Depressive or manic episodes sometimes include psychotic symptoms, but not always. Certain drugs such as LSD, mushrooms, and other psychedelics can also cause psychotic symptoms.

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Recently, I heard the term decompensate for the first time. The therapist seemed surprised that I had never heard it.

Given the definition of compensate – to reimburse – I thought decompensate might mean something along the lines of having your disability payments taken away. You might say something like “Social security just decompensated me, now what am I going to do?” or “Bipolar disorder decompensated me, and now I have no money to pay the bills.”

The therapist explained that decompensation is what occurs when everything you’re doing to prevent a mood episode (to compensate for the illness) just isn’t enough.

When I mentioned to Dr. Fink that I had never heard the word, she said I must be a big dummy. Well, she didn’t actually use those words. Here’s what she really said.

Cecie Asks…

I’ve been told that it has become increasingly the norm to only take the anti-psychotic medications and the heavier hitting mood-stabilizers for a limited period of time to get the moods and scary thoughts under control (when you feel an episode “coming on” or to recover from an episode you were unable to avoid) and then to stop them when you are stabilized.

I guess the idea is…

1. You don’t have to be under the effects of these medications any longer that is absolutely necessary.
2. These medications are actually more effective when used for only a short period of time, during the “acute” phase of the illness.

My questions are:

1. Is this something you recommend to some/all of your patients?
2. How long can I expect to be on an anti-psychotic medication and stronger mood-stabilizer after a manic episode with psychotic features?