Son's Ativan "desire"
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Q:  Son's Ativan "desire"

Hi Dr. Phelps,

My 20 y/o BP son is having terrible anxiety mostly in the evenings.. He is on Depokote ER 500 am and 500 pm and 10 Zyprexa pm. Please help! I am worried that he will get addicted to Ativan. He is asking for it everynight. He is phobic about blood draws which makes it impossible to know what his Depokote Levels are. The Doctor won't add Lithium because the doc cannot monitor it. What anxiety medicine to you give (if any) to your patients? Have you seen BP patients get addicted to Ativan? Any suggestions? Thanks, Jayne

Dear Ms B' --
Sometimes (most of the time, in my opinion) in this context, the Ativan "desire" serves as a marker for the continued presence of a "manic" component, i.e. a high energy component.   If there's no antidepressant around, the only medication approach is to try to get more mood stabilizer on board.  Your son probably has gained a lot of weight, with the Depakote and Zyprexa, so it would be scary, I'm guessing, to add more of one or the other.  That means looking at the rest of the mood stabilizer list (4th item on first list; opens as Word document); see also, as you may already have done, the list of alternative mood stabilizers as described on my site under "treatment details".  Lithium is a candidate, though also can cause weight gain.  As I know you have pursued, time for some input from someone who's comfortable managing complex bipolar disorder -- e.g. who can tell your current doc' how to do the lithium, or some alternative. 

Dr. Phelps

Published July, 2001


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