BP Partner Had Steroid Injections...
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Q:  BP Partner Had Steroid Injections...

I live in Spain with my partner who was diagnosed with manic depression 18 months ago(he is 37 years old). He was successfully treated with Tegretol until January when he went to his General Practitioner with back problems. She prescribed a course of what I have since found out were corticosteroids. (a 6 day course of injections). The back pain persisted and he was given another 6 day course. The back pain continued and unbelievably another 6 day course was prescribed. From the beginning she was aware that he was taking Tegretol and that he was taking it for Bipolar.  His sleeping patterns were only slightly disturbed during January and quite unexpectedly a week after finishing the last course of injections he had a manic epsode,was hosptalised for a month and is still on medication to reduce the mania.  My question is am I justified in feeling anger at the doctor's negligence in prescribing corticosteroids (over a month) to someone that suffers from bipolar?

Dear Helen --
Being angry, being frustrated, and wanting to do something about this are all very understandable and "justified".  

Now, for the next statement, this is going to sound like a doctor defending doctors.  That may be part of the basis of my response, in that I haven't been sued yet but I know what it would do to me.  I'd sure want someone to think that I was doing what I thought was best, and out of a genuine wish to help, and that doctors are mortals too who can't be expected to know everything -- especially general practitioners, who are expected to know an absolutely incredible range of things that I'd be quite overwhelmed to take on (I did that for a year and it was petrifying).  

Ok, next statement:  actually, there is nothing in the standard of care that says "hey doc, you're supposed to know that steroids can cause bipolar disorder to get worse, and to screen for bipolar disorder before you give them".  That would be good --although the oncologists I work with, who use steroids quite a bit in some patients with cancer, estimate that they see bad reactions about 1 in 100 times.  They now know from working with me that I'm wanting to be watchful every time someone with known bipolar disorder is given a steroid, and that I'd rather avoid it if at all possible, but I have had several patients with clear bipolar conditions get steroid injections like your partner and do okay.  In other words, we haven't really reached the point where we can even say unequivocally "don't give steroids to someone with bipolar disorder", let alone expect doctors, especially general practitioners, to know or practice this.  

Nevertheless, I would expect all that verbiage of mine there to make you feel any less frustrated.  It doesn't matter what the intent was when something really bad happens from a treatment -- it's still something really bad.  I think all we can really ask is that the doctor listen up when given feedback (preferably in a way that makes it easier not to get defensive) and incorporate that feedback in future practice, at least in a situation like this.  Sorry to hear the story. 

Dr. Phelps

Published April, 2002


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