When to Go to the Hospital
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Q:  When to Go to the Hospital

I was dx in April. In Aug. and part of Sept. I was manic and managed to avoid being hopitaized. Now just when I thought stablized again I have gotten very depressed and can not even get my self to go to Commuity Allanice most days and take of myself. I have had suicidal thoughts and thoughts of how it can be done. I have not acted on these though.

How does a person know when they should go to the hospital and get help? Or should I tell my Dr. and let him deside?


Dear Mary -- 
"Yes": you should tell the doc' and let him help you decide; and you should try to make the decision yourself so you demonstrate you're taking responsibility for maintaining your own safety, which really helps your treatment team (they will worry less if they think you're monitoring safety yourself and capable of saying "I probably better be in the hospital now" instead of finding yourself taking action on your thoughts.  

In general we think about using the hospital for safety when someone can tell they're on the verge of acting on their suicidal thoughts.  Some people are more impulsive than others, and they may need to be hospitalized with a lower "threshold"; whereas someone who is going to think and plan and even communicate that planning, without nearing the brink of action, can work with her/his treatment team sometimes and avoid having to be hospitalized.  It's really up to you and your team, thinking together.  So, yes, tell your Doctor.  

Note that it is almost the norm' for a depressive phase to follow a manic phase.  So the September experience almost predicts that you would land where you are now.  And just as you cycled out of the manic phase (medications may have helped), you will almost certainly cycle out of this depressive phase as well.  Mood stabilizer medications can decrease this cycling back and forth but sometimes it can take a while.  

What to do about your depression in the meantime?  That's pretty controversial.  Some psychiatrists would give you an antidepressant on top of your mood stabilizers; others would use "antidepressant" mood stabilizers like lithium and lamotrigine; others would hang in there with your mood stabilizers and watch to see that the depression is getting slowly better, only adding an antidepressant if there's no movement, or worsening.  (I'm one of the latter, usually, unless the depression is clearly dangerous, as it sounds yours might be).  Call the doctor today; and go to the Emergency Room if you can't make contact and things are getting worse.  

Dr. Phelps

Published December, 2002


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