Expert: Ivan Goldberg, M.D. - 12/8/2008

Question
My 20yro daughter was diagnosed 3 years ago with Cyclothymia and possibly bipolar. She has been off and on medication. She crashes and leaves home for 2 months or so uses all kinds of street drugs when gone,then shows up and wants help. She has been on Lamictal, seroquel, lithium, vitamin therapy, trileptal and abilify. About 4 weeks ago she came home again and she was manic and tends to run on the manic side of bipolar, I started her back on the trileptal and she is taking 300mg 2x a day. She still has the angry,unpredictable edge. Also,3 days ago I found a bottle half full of rum under her mattress. Today she stated that she was going to leave again soon. I started her back on the Abilify 15mg along with the trileptal. I am trying to get her to a doctor, but many times she has left me hanging with the appointment because she has left home. When she was on the trileptal and abilify before she had done pretty good that is why I decided to go back to it. She also tolerated the lithium quite well..but was still on the manic side. I am exhausted and do not like managing her medications alone and this revolving door is killing me. Do you have any immediate suggestions. Thank you so much for taking questions like this so many people need real help. Thank you

Answer
Hi Margie . . .

The horrible situation that you describe is all too common because many people with a disorder in the bipolar spectrum have little or no insight into how severely abnormal their behavior becomes at times. While they dislike the depressive episodes they have very poor judgment and often will turn to alcohol or other street drugs for relief. When "up" . . . hypomanic or manic they often have no insight into how disturbed their behavior may be.

The combination of an anticonvulsant mood stabilizer such as Trileptal and an antipsychotic medication such as Abilify is sometimes prescribed by psychiatrists when they are treating people with a bipolar disorder. As both of these drugs can cause serious, potentially life-threatening side effects, their use should be supervised by a psychiatrist familiar with their use.

I think you should seek out the local chapter of the Depressive and Bipolar Support Alliance. You can locate the chapter closest to you at:
http://www.dbsalliance.org/site/PageServer?pagename=support_findsupport

Best regards . . .

Ivan
%%%%%%%%%%%%%%%%%%%%%%%%%%%%%