Q: Wife Considering Stopping Meds
She also is a very big fan of yours and respect your opinion very much.
So, Dr. Phelps, a long-winded question, what would you say to her?
If you agree with her, what are the steps we should take?
Dear Mr. L' --
First, the medications are not quite enough if pre-menstrual increases in symptoms still appear; likewise if mood is still "swinging", especially at other times. If she's still having symptoms, the point is, it's very unlikely coming from the medications -- for example, from your note it sounds like what's happening is what was happening before the medications, just less so.
In that case, stopping is almost certain to lead to a worsening. So as you imply, at minimum she should very slowly taper one agent and see what happens.
Sounds like there's something about the medications she doesn't like, some side effect? Weight gain would be the most common. But there are many ways around that (lower doses, fill in with something else; switch to Trileptal; add topomax enough to blunt appetite; look at thyroid replacement as a mood stabilizer -- for example). So I'd recommend keeping the focus on controlling symptoms and working around side effects. Then, when you've got that done, if she's still just sick of taking medications to stay well -- and lots of people feel that way too -- then try the slow taper of one medication at a time, if you must; and all in very close communication with the prescribing doc'.