Treatment Plan w/ 3 Different Antidepressants?
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Q:  Treatment Plan w/ 3 Different Antidepressants?

I have a friend/co-worker who had an acute occurrence of what was diagnosed as manic-depression. One day nothing, the next week unable to work or do much of anything else.  She is getting better, but a couple of days ago her doctor prescribed Wellbutrin and Prozac for her. She was and is still currently taking Zoloft that he prescribed.  Is three different anti-depressants a normal treatment plan?  I know it takes around a month for some medications to build to a therapeutic blood level. Yet he changes some meds as much as twice a week. Am I just an overly concerned friend or has her doctor adopted a treatment plan considered outside standard operating procedure?

Dear Mr. S' -- 
I cannot think of any condition, let alone bipolar disorder, that calls for 3 antidepressants.  If she really has bipolar disorder, the situation she is in is, in my opinion, a relative emergency (e.g. this week the U.S. Food and Drug Administration just called for a warning to accompany antidepressant medications so that patients know they have been associated with causing suicidal thinking and action -- and many mood experts think that this is more likely, or perhaps virtually exclusively associated with, bipolar disorder.  Here's a
summary of that FDA action in case you want to use it as part of your covert operations -- a phrase I use here intended with a smile and support of your friendly concern.)

 Usually I'd say something like "well, since she's not my patient and I've never seen her, there might be factors involved that I don't know about that explain and justify this course of action, etc etc"; but not 3 antidepressants, and especially not in the context of a possible, let alone diagnosed, bipolar disorder.  Here are some thoughts on talking with doctors in case someone whom you get involved might be able to use them.  

However, I should add that I'm offering here my opinion on the general issue of antidepressants in bipolar disorder, as summarized in that link, and not a recommendation on this particular woman's care.  Perhaps, for example, he intended the Zoloft to be replaced by Prozac and did not make that sufficiently clear to her?  Maybe she's already on some sort of mood stabilizer and even she doesn't know it as such to report it to you?  You should not assume, and I'm reminding myself here to do likewise, that the doc' is completely off base.  In fact, you're probably more likely to get good results if you lean over backward to find a way to understand and support his actions as a starting place for further inquiry.   

Good luck; watch your step. 

Dr. Phelps

Published June, 2004


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