Treatment Plan & Zyprexa
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Q:  Treatment Plan & Zyprexa


DR.PHELPS,
I WAS DIAGNOSED 11 yrs. AGO W/MANIC DEPRESSION.  I DID NOT METABOLIZE LITHIUM AT ANY DSG. SO WE TRIED TEGRETOL. (I AM NOW 42)600 MGS. 2xDAY NOW MY DR.(M.D.) HAS ADDED 10MGS. OF ZYPREXA TO THE MIX. HIS PLAN IS TO INCREASE DSG. EA. MONTH.  I DON'T KNOW WHAT THIS DRUG IS EXCEPT IT IS SUPPOSED TO HELP MY MANIA. I ALSO    TAKE   ATIVAN 2MGS. 3xDAY, DILANTIN 200MGS.am 300 MGS. PM, TENORMIN 50mgs. 2xDAY,PLAVIX,  NORVASC, ZOCOR, SOMA(PRN), EVISTA, GEEZ I THINK THAT IS ALL.  I SUFFER FROM SEVERE   MIGRAINES AT LST 3x A MO. HAVE HAD CERVICAL FUSION, DBL BY-PASS SURGERY, AND   RADICAL TMJ SURGERY.  I LIVE IN AL. VERY, VERY RURAL AND CANNOT FIND ADEQUATE   PSYCHIATRIC OR PSYCOLOGICAL HELP.  I ALSO HAVE SEVERE PTSD ANY HELP WOULD BE SO   GREATLY APPRECIATED. 

THANK YOU,
KIM


Dear Kim -- 
Believe it or not there are a lot of folks out there like you.  I have quite a few in my practice.  One looks at the medication list and quivers.  Other doctors look at it and think I'm nuts to be using so many medications.  Interactions between them are common, such as your Tegretol lowering the levels of many of these medications, including the Zyrexa so that you'd have to take pretty high doses to get the usual effects). 

Now Zyprexa does appear to be a good "mood stabilizer", like Depakote and others; a recent study showed better outcomes over time than with Depakote.  So it's a good choice in some respects, but from you're list I'd bet weight could be an issue to watch with the Zyprexa.  

In general you'd have to be looking for medications that would replace medications already on your list.  That's going to be tough.  Another approach would be to say, hey, you're on a ton of med's, is there any other modality that could help besides pills?  There are several candidates there:  first, a regular physical activity program should be mandatory, whatever it takes (people have tons of reasons why they can't, but just about everybody can do something if their life depended on it, which in this case may be fairly literally true).  That can help with sleep, pain (believe it or not), blood pressure, weight management -- not to mention all the generic benefits like lowering heart risk.  

Then there's psychotherapy.  That could be hard to come by out where you are.  Some practitioners are starting to offer online therapy, but watch out there and be extremely rigorous about making sure you're dealing with someone reputable, ethical, and who will give you something for your money (and money it will take...). 

Then there's moving to somewhere where you can access services, I suppose.  And there's a lot of good material out there on the net and in bookstores, libraries -- you can make quite a career out of trying to read through the self-help materials that already exist, some of which are really good (again, watch the pocketbook and the source).  

I fear that's not really telling you much you didn't know, but these are the things that come to mind reading your letter.  Good luck with all that. 

Dr. Phelps
 

Published August, 2002

 

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