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Q: Concerned about an SSRI Staying in the Treatment Plan
I keep reading via those considered experts (mainly docs
who have authored books on the subject) in the area of Bipolar II, that SSRI's
are contraindicated, especially long-term, yet my mother takes Lamictal,
Seroquel, and Celexa. I question the Celexa, as her history is full of negative
& even life-threatening reactions/side effects to most of the long string of
SSRI's that have been prescribed by 2 psychiatrists over the years. Now she is
with a new practitioner (MNHP) who seems good, but has chosen to keep her on
Celexa, when rapid cycling, severe depression and suicidal thoughts have been
part of her history. I would welcome your opinion on this.
Thank you!
Dear Rev’ --
Of course there may be reasons why people maintain the antidepressant in your
mother's case that I would not understand without a thorough background. That
said…
In general, I think the majority of mood experts I read (with the exception of
Gordon Parker and Jay Alexander and possibly Mark Zimmerman) are very concerned
about the potential for antidepressants to make bipolar control more difficult.
That is probably the signal you are detecting in your reading.
However, I think there is almost complete consensus that in rapid cycling and
mixed states, if an antidepressant is present, one of the best ways to treat the
problem is to gradually remove the antidepressant -- despite the fact that we
have very little data on this issue from studies directly examining this
problem. I have summarized those data on my website, on the Antidepressant
Controversies page,
controversy 2. You could present
those data to the nurse practitioner with your concern. Here are some thoughts
on how to convey that concern gently and hopefully effectively, in my little
essay on
how to talk with doctors.
The overall point is that one must proceed carefully, not assuming any
particular approach is clearly correct, generating an interest in examining
alternative approaches, and then working from the existing data as one chooses
amongst options. As you can imagine, that goes for most of psychiatry, not just
this particular question.
Good luck with the process --
Dr. Phelps
Published July, 2008
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