Expert: Joyce A. Anthony - 10/9/2009

Question
Hi Joyce,

My name is Brittany and I am a mental health therapist working with the SPMI population. I am by no means an expert, but I feel that I have a great knowledge base about mental illnesses and treatments. It's one thing to treat a client, however, my current issue is regarding my father. He was diagnosed with Bipolar Disorder roughly 7-8 years ago (age 48-49) however he experienced mood swings well before this without being diagnosed. He was put on Lithium by his PCP however he only took this med for roughly 1 month. He then stopped his med without telling his doc. Since that time he has been on a slew of different antidepressants (without mood stabilizers I might add) which would send him into a manic episode without fail. He has most recently been on Lexapro (2-3 yrs ago), Pristique (1 year ago, for 1 year), Abilify (currently taking-4 months), Lamictal (currently taking-1 year), Paxil (currently taking-1 week) and Ativan PRN. A few concerns:

#1. He will only see his PCP, and absolutely refuses to see a psychiatrist for meds because he feels that a psychiatrist will only judge him and he doesn't want to "talk about my feelings."

#2. He goes through a very predictable cycle...he will get on a new med regimen which will either bring him down from a manic episode or up from a depressive episode. Once he feels what I'm deeming as normal, he reports feeling "not himself." He will go to the PCP who then changes his meds! He has rarely been on a steady med regimen for a long period of time to see if it actually works.

I want to know, do you think a PCP can treat an individual with BPD properly or is a psychiatrist needed. Also, how do I get him to realize that this is a disorder that he can live a very normal life with if he just stuck with the program!? Advice please! I love my father and I want him to have a normal life. This is driving my mother and I up a wall...

Answer
Hi Brittany:

A PCP can effectively treat bipolar disorder as long as he/she is familiar with it.  You might make an appointment to discuss this with your dad's doctor and see how familiar the doctor is with bipolar disorder.  

This would be a good time also to discuss with the doctor your dad's routine of changing medication too often.  Enlist the doctor's co-operation in seeing that your dad sticks with one particular medication and doesn't change unless things are getting too unstable.  Lamictal is a wonderful drug for bipolar, but the Paxil is well-known for bringing on mania in bipolar patients.

The doctor may not be able to give you information because of confidentiality laws, but let him/her know you want to give them some information and are not looking to get information.  Doctors are allowed to receive information on their patients.

Other than that, maybe you could get your dad to attend some kind of support group?  It may allow him to see that he can live a full and productive life.  

                           Joyce A. Anthony