Meds, Manic Phase, Illicit Drugs
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Q:  Meds, Manic Phase, Illicit Drugs


My husband was diagnosed with biploar mania, in 1997. We have been through many manic episodes. Recently he has been prescribed new medications:
He is taking:
Zeprexia
Zanax
Effexor
Depakote
Paxil
This to me seems a bit extreme. Unforuntely, during this manic phase he is also using illicit drugs as well, unprescriped Loratab and marijuana.

He has a dual diagnosis of Addiction/Bipolar/Manic/Rage Disorder/OCD.

How do you deal with this? My insurance does not cover any detox if oppits are involved. I am not a doctor but I don't think a body should have this many mixed chemicals. Pls. Response if you have any suggestions.
Thank you.


Dear Ms. H' --
Your concern is understandable. Although many patients with bipolar disorder take several different medications in order to keep their symptoms controlled, and 5 is not unusual, it is still a lot of medications -- especially for someone who may have a problem with taking pills to solve problems.

As things go along you could wonder aloud whether perhaps the combined antidepressants (Effexor and Paxil) could contribute to continued symptoms. In my experience, whenever I'm really struggling to help a patient get better, I'll try to take the antidepressant (usually it's just one) out of the picture. Sometimes it has to be added back later, but for many patients, things never smooth out until the antidepressant has been removed from the mix.

Sometimes things are smoother enough, then, that fewer of the other medications are necessary. That would be nice to hope for here.

Finally, if you're having good luck working with his doctor (e.g. according to the Bipolar Disorder Survival Guide, a good book by Miklowitz; and/or according to some guidelines from my website on talking with doctors), you could also wonder whether for someone with symptoms like his and his substance use history if perhaps clonazepam, a cousin of Xanax, might be a better member of that particular family to use in his case.

Good luck with the process, an often long and hard one, but not impossible. Have you heard about Al-Anon yet? That's often a great resource for folks whose significant other is using.

Dr. Phelps


Published November, 2003

 

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