Expert: Libby Bonner - 11/26/2008

Question
My 22 year old son was diagnosed as bipolar in May of 2007 after he received Cymbalta from his college to treat depression.  That pushed him into mania.  After being non-compliant on Lithium, he relapsed in October, 2008, and was placed on Zyprexa and Depakote ER.  He is doing much better, and they are tapering off the Zyprexa.  My question is regarding the paranoia.  Does it tend to subside with continued treatment or does it normally stay with a person, even when properly medicated?  He is handling the paranoia with a degree of grace and knows it is not "reality".  i am hoping and praying that since he is only 5 weeks into medication therapy that it will subside.  Thank you for listening.

Answer
I'm sorry to hear of your son's illness, but glad that he is improving.

I hope you will address your Q to your son's docs, as well as to me.  I really don't know how long it takes Depakote to kick in.  I think not as long as antidepressants, but not sure.

What I feel more certain of is that he probably shouldn't still be experiencing paranoia by now.  Perhaps he has still not found the right med/s, right dose/s, that will fix things optimally. It takes some tinkering, always....and is a terrible trial for pts and families.

It is more usual than not for bipolar pts to take more than a single med and it may be that a second one is needed.  Is there a reason not to use lithium again?  His own preference, perhaps, which is certainly a consideration....but unless he experienced toxicity, it might be the likeliest 2nd med....though there is no scarcity of choices.

I wouldn't spend a great amount of time and talk on the paranoia.  From my experience and observation, I would guess that he doesn't believe it's not reality, but loves and trusts you and is being perhaps less than truthful about his beliefs, because he sees it is such a worry to you.

You apparently have done your homework on his illness.  I hope it will have perhaps led you to two resources.  One is NAMI, nami.org.  I do hope there is a good affiliate near you, one that has family support as well as "speaker" meetings.  The other is a book to buy and use.  Author is Woolis.  Title is When someone you love has a mental illness.  It is a book for families, and is about the lived experience of mental illness, about which docs are so ill-equipped to help families.  I'm sure Woolis covers paranoia, among much else.

I have just recently discovered an absolutely fabulous resource, helpguide.org.  Their material on helping a person w/ mental illness is just excellent.  But do get Woolis: it's my desert island book.

Last thought.  Do get releases signed w/ all providers, now and in the future, when/if your son is willing.  Otherwise there may come a day when no doc will talk w/ you about your son.  You need a Release of Information form, naming those to whom his info can be given.  It's true usefulness is permitting you and providers to exchange info.

Also, since he acquired a chronic illness while a student, and thus as an unemancipated minor, it's possible that your family's health insurer will grandfather him on an existing policy for life.  Some insurance companies do this, so check.  Paying for his meds, or him getting coverage where he works, is going to be an ongoing problem.

Thank your so much for writing.  Most newly diagnosed bipolar patients do really well these days, w/ so many good med choices, and so I am very hopeful for you.

Well, a last, last thought.  If he will be on a campus again, it's possible that there might be a campus NAMI chapter.  Whether or not, I think it's awfully good if patients [consumers, in NAMI-speak] have contact w/ other patients.  It's destigmatizing, and gives them a chance to pick up useful info on illness self-mgt, docs, meds, etc.