Q:  Testosterone & Treatment Plan

My spouse takes depakote at night(500mg) can take up to 3 klonipines  (1mg) at night and can take zyprexia which he does a good bit. He takes a multivitamin,1asprin, 1 prinival and sometimes fish oils, vitamin E.  He seems to be doing well on this  but at times seems depressed. He says that he has aches and pains and has trouble focusing/alert. He is 46 yrs. and has been on these medicines almost 5years now with no major highs or lows but I do worry. As he gets older, isn't there anything natural that can be used with these meds?  I am wondering about testostrone. I have heard that it really helps in more ways that sexual. Do you have any info on this?

Thanks,
Lynn
 

Dear Lynn -- 
The way you describe his medications, it sounds like the doses vary quite a bit -- perhaps because he increases the dose when necessary to deal with difficulty sleeping (most likely guess) or anxious feelings?  If that's the case, then we might guess his bipolar disorder is still actually "cycling", at least a little bit?  

If that's the case, then the "at times seems depressed" part could be part of the cycling too.  In that case, which we'd call "rapid cycling" (if there are more than 4 such episodes a year, which certainly sounds likely), it's important to know that most mood experts agree:  don't treat the depression one sees in rapid cycling with an antidepressant, or anything else known to increase cycling, such as an androgenic steroid -- testosterone.  We treat instead by focusing on getting the cycling to stop.  Most (but not all) people will then not have the depressed phases and not need to consider the kinds of treatments you're thinking about. 

Of course there were a lot of "if that's the case" phrases here.  I'm making a guess based on what you've described.  I could be completely off base, and there could be some other explanation.  But that dose of Depakote is definitely on the low side (a blood test is available to see if his level is also low; or sometimes, if he's not had trouble before with higher doses, we just turn it up to see if things get better, as long as no new side effects turn up.  Now don't do this without talking with the doctor first, mind you.  There could be some very good reasons why she's kept the dose that low).  Most people taking Depakote, if it is the main medication used for bipolar disorder, take more than 1000 mg daily (the numbers sound big because each mg doesn't have much oomph).  

Generally it is best to start with the treatments that have some clear evidence that they work.  Those options are presented in this summary of mood stabilizer options, including a table listing all of them, followed by their pro's and con's.  After reviewing them, you might want to talk with his doctor about those choices.  However, there are two clear options without medications at all that have been studied:  exercise as an antidepressant; and a regular sleep pattern to decrease cycling.  

Good luck with all that!

Dr. Phelps

Published June, 2004