Having a Really Hard Time-What to Do?
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Q:  Having a Really Hard Time-What to Do?


Dear Dr. Phelps,   "IMPORTANT"
I was on 1000 mg depakote for 4 years and geodone 40 mgs. until May when I was
hospitolized for an episode.  After that my pdoc kept me on 1000mg depakote but
raised my geodone to 80mg.  Since then he has been taken off my insurance  so I saw
a interim pdoc two weeks ago on an emergency one time only basis.  He prescribed
4000 mgs depakote and 400 mg geodone and I am having a really hard time.  Sleeping
for days then not sleeping for days, racing thoughts, severe restlessness...headaches even slurred speech on two occasions.  It will be two weeks before I get in to see another pdoc and don;t know what to do in meantime.  Should I go off of all medication?  That is what I want to do.

Thanks for your advice in advance.

________________________________________________________________________

Dr.
This is just a follow up to my previous e-mail a little while ago.  I think I need to add some things.  My job thinks I am drinking on the job because I keep falling asleep and saying off the wall stuff.  Plus my entire family committed suicide I am the only survivor.  My Mom did herself in in January. She was diagnosed bp and had frequent electroshock therapy for mental illness. My rest of my family though never diagnosed just did themselves in: brother , father , cousin and grandmother. 
I was told I had bp back in august of 2001 though had been being treated for it without knowing it for 4 years after a previous hospitol stay.  I have in the past been on  things like Topamax, resperdal, serzone, zyprexa, trazadone. ambien, klonapin ect and since last year just the depakote and geodone. 
Anyway hope this addtl. info helps....Oh yeh, my last hospitol stay in May was after 10 days with no sleep and no food and I took knived to therapist office and tried to slit wrists and stabbed him instead...I feel so messed up I don't know what to do.
Thanks Tanya
 

Dear Tanya -- 
I worry that because I'm writing this possibly weeks after you wrote, things could be worse; I hope they're better, which probably would have to do with someone having gotten involved and lowered your doses.  If that hasn't happened yet, you need a Depakote level (reads "valproate level" on the lab slip) NOW, in an emergency room if that's what's necessary to get it done quick.  Not that you're going to die from your Depakote being too high, but if the level is way high, I hope that would be a quick ticket to getting something done about the whole picture you describe.  I've asked the BipolarWorld folks to forward this to you ASAP. 

Your doctor, or the outfit for which he works, probably recognizes that you have a really severe version of bipolar disorder.  Under the best of circumstances, there ought to be a pretty formal game plan for how you're going to be treated, i.e. how the team is going to proceed from this combination to that combination to combinations used with ECT, and so forth.  Sounds like genetically you're pretty set up to have a rough go, so you're going to need a pretty good team who's working pretty hard.  

Unfortunately it sounds like the team is not pulled together yet; with a new doc', and so forth.  So this might be a rough phase in something that could get smoother later (you might need to read about hope in this condition).  Make sure you know about all the mood stabilizer options, to help the team come up with combinations you haven't tried yet.  Sounds like you've learned to avoid antidepressants, as they aren't prominent on your list.  A colleague who does ECT just told me yesterday about a patient he has on 3 or 4 mood stabilizers plus ECT, a combination I'd not heard of, but apparently she's doing pretty well with that.  So, keep looking for help with this.  There's almost certainly something left to try, yet.

Dr. Phelps


Published September, 2002

 

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