Worried About What Will Happen...
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Q:  Worried about what will happen...

dear dr. phelps-
i am 42 years old with long history of depression.  in jan.99 i got a head injury in car accident and had many (non-convulsive) seizures and was pretty much out of commission for 1 1/2 years.  diagnosed with epilepsy and was on mainly dilantin.  didn't stop all symptoms - i was nauseous ALL the time and had lots of weird problems with visual stimuli.  anyway, i got lots better and went off of meds and went back to work.  i still had mild symptoms but i could live with them. i was better for about a year and a half.

now i am severly depressed.  i believe i have bipolar II, since occasionally i have a good day and get something done.  lots of days i can't get out of bed.  i'm not working and am totally broke.  i go to bed hoping that i die in my sleep. i have been having lots of suicidal thoughts which i never had before.  i am just so sick of everything and have no motivation to get help.  i live in a rural area with no psychiatrists or neurologists close by and trying to find someone is a huge ordeal.  i'm afraid of what will happen if i tell people how much i want to die.

i think i have a complicated situation that's a combo of neuro and psychological problems.  i don't know how to get the help i need.  i have been on zoloft off and on over the years.  it seemed to work ok before but now it isn't.    i can't figure out how to get help and i'm getting really worried about what will happen if i don't.  please answer asap.



dear wendy -- 
well, first off you might (but I have to repeat might) be surprised to see that if you acknowledge your suicidal thinking, you could end up in a psychiatric hospital all right, but it might be a good thing.  That would take you quickly into a setting where someone could try to help directly with this combination mood/neuro problem (as I suspect you're quite right about that part). 

in the interim you could teach yourself about the mood stabilizers that are also used to treat epilepsy.  note that dilantin is not on that list.  the point is that there are other anticonvulsants that are also used in mood disorders.  the most prominent on this list for your purposes is lamotrigine, which has strong antidepressant effects (too much so sometimes, as you'll read).  But even Trileptal would probably be worth a try: sometimes it, and even Depakote, have some antidepressant-like effects. 

So please do tell somebody, "asap" as you say, about your thoughts of suicide.  If you were my patient I'd actually have to send somebody out to check on your safety, it's that important.  I'll have to rely on the electrons, in this case. 

Dr. Phelps

Published September, 2002


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