MS & Bipolar - Meds
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Q:  MS & Bipolar - Meds

My family is a true case study in the genetics of bipolar disorder. My mother passed away at age 67 after suffering a lifetime of untreated mood swings w/eating disorders, and self destructive tendencies. My BP appreared at about age 13 but was treated as dysthymic disorder until age 40. My new MD, has been trying to get the rapid cycling (which I've had for 25 years or so) under control to no avail.  My son, age 19, has been confirmed as BP rapid cycling, refuses treatment and is self medicating with alcohol and marijuana. We sent him to rehab but he fell right back into addiction the day he got out. My daughter, age 16 is also BP. We were just told her thyroid levels are out of range. Not a surprise. I'm told though my levels are normal, but my thyroid is enlarged. I'm freezing all the time and can't lose weight. I can't count how many doctors have looked into my eyes any asked me if I have been checked for thyroid problems. (I do have big brown eyes, not bludging, but big) My levels always manage to come out within the normal range.  Add to all of this, all 3 of us have been diagnosed with ADD. Something, by the way, my father had. So I guess they were right when they said, "the apple doesn't fall far from the tree".

Meanwhile for my question:
I'm trying to fight two battles at once that contradict each other. Not only do I have Bipolar disorder (w/rapid cycling) but I also have MS (1 major attack so far). I've read that there are studies that show a "link" between the two diseases. Problem is, while I suffer from the exaustion caused by the MS, I can't take anything for it because even at the the lowest doseage, these medications activate me. I don't even want to think about about having another attack and taking steroids again long term. I was ready to be locked up last time. I'm in the early stages of the MS but fear that as it advances I'll be up the creek without a paddle. Currently I'm taking a cocktail of Topamax, Seroquel and Neurontin. I'm still cycling about every 3-5 weeks or so. These drugs leave me with short term memory loss, sluggish, and clumsiness. Needless to say, things I don't need on top of my already developing MS symtoms. 

Please help. Is there hope for someone with this combination of problems? I'm tired of the rollar coaster and want a fighting chance to have the energy to get the exercise to not grow old before my time. I'm 44 and already feel like I'm 60.

Dear  Ms. S' -- 
Pardon me while my knee jerks, it will settle down in a moment.  Started up when I was hearing about needing some hope -- while the medication regimen is three medications none of which is known to be a mood stabilizer per se (Seroquel comes the closest perhaps), and two of which are associated with worsening symptoms.  Now you may have gotten there very logically (i.e. by working your way through all the usual "first line" agents like lithium, Depakote, etc.) but I just wanted to pass along that on first glance at your story, that mismatch sticks out. 

Secondly, can a person with bipolar disorder take steroids if they're absolutely necessary?  Definitely:  I've seen that circumstance several times where I'm called to consult in the hospital for someone who's gone psychotic on steroids but needs them for some life-threatening condition like brain swelling or some cancer treatment regimen.  

In that case we just treat much like usual:  rely on mood stabilizers, watch out for anything potentially destabilizing, and if moderate doses of the first and/or second agent can't control the symptoms (and higher doses produce side effects like the ones you describe), then add yet another mood stabilizer.  The link shows you a sort of unofficial list with links for more information on each medication.  

After you read that you might need to read the essay on Hope, but it was written for someone who's been on more ineffective medication regimens than I'm gathering you've had thus far (in 4 years of treatment, if I hear correctly).  In any case, I think hope is warranted and I "hope" that you'll find a basis for that soon. 

Dr. Phelps

Published April, 2003


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