Re: Wife's Treatment Plan & Zoloft
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Q:  Re: Wife's Treatment Plan & Zoloft

Dr. Phelps,

My wife has recently been diagnosed with BP II disorder.  Her symptoms include severe depression but also severe anxiety, agitation, restlessness, etc. as discussed on your website with regard to the "bad side" of hypomanic energy.  The symptoms seem to worsen prior to her menstrual period and gradually improve to a point where she is feeling much better, only to plunge again prior to her next period.  

One week ago, my wife returned from a month in Johns Hopkins hospital, where she received ECT (14 treatments) and tapered off the complicated medicine regimen, heavy with antidepressants, which her local psychiatrist had her on.  She returned home on lithium (900 mg) seroquel (400 mg plus prn of 50 mg up to 4x/day) synthroid and zoloft (50 mg per day during the week preceding menstruation).

Unfortunately, after just a few days at home she has suffered a near total relapse of her symptoms.  At the advice of the JH doctors and her local doctor, she has now begun taking lamictal, adding it to the regimen outlined above.  Because she is so distressed at the return of her symptoms and has had suicidal ideation (though she doesn't believe she will act on it), and because it takes a while for lamictal to reach an effective dose, the doctor also has suggested adding a dose of 100 mg of zoloft to be taken throughout the month.

Based largely upon what I have read on your website, I have resisted the addition of the 100 mg of zoloft to the regimen.  I am concerned that it may be contributing to, or worsening, my wife's mixed-state-like symptoms of agitation, sleep disturbance, anxiety, racing or painfully slow thoughts, etc.  My wife is confused and just wants to do whatever will help ease her suffering.  The doctor (who apparently does not share your concern about the use of antidepressants in BP II depression) has said that while he thinks the zoloft would help, we don't have to follow his recommendation and that if we want to wait for the lamictal and use the seroquel and lithiium in the meantime, then he will permit that.

My question is - am I doing the right thing in resisting the addition of a round-the-month dose of 100 mg of zoloft?  I don't want to jeopardize either my wife's safety or her recovery.  


Dear Mr. K' -- 
You are correct in your interpretation of my general concerns about antidepressants. As for how they apply here, I would have to defer to your consultants as they know much more of the background than I. 

Dr. Phelps

Published October, 2006


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