Expert: Joyce A. Anthony - 7/2/2009

Question
QUESTION: I need to tell my doctor I am uncomfortable with changes he is making to my medications.
I am 37, married 20 years, have 3 teenagers, and have been trying to get some degree of stability for about 10 years. I had been having 4 or 6 episodes a year since my mid twenties.
 Last April I had a very scary episode and admitted myself to the hospital. The episode lasted about a month with the mania lasting about 10 days. I stayed 5 days and swore I would never allow that to happen again.
 I was very unpredictable and would not go out in public unless I absolutely could not avoid it. No dates with the husband and no job since 2000. I felt like I couldn't take the risk of making a fool of all of us with my behavior.
 For about a year, along with therapy, I have been taking the maximum dosage of an antidepressant, a mood stabilizer twice daily, and a sleep medication as needed (3-4 times weekly). I was also taking a mild benzodiazepine once daily as needed (0-3 times weekly) until 5 or 6 months ago.
 Since last summer, I have been feeling functional. I have been going out more and actually talking to people when I do. The anti-anxiety medication helped. If I began to feel angry or irrational,they helped me to calm down enough to wonder if my behavior was acceptable.    
 Earlier this year, My doctor said he had some concerns about the amount of medication I was taking. We did away with the benzodiazepines.
 In March, I had a mild episode lasting about 2 weeks. I spoke to my therapist and told her. She suggested I see the doctor. I refused. I was and am afraid to go back to the hospital and I told her that.
 About 3 weeks ago, he lowered my dosage of my antidepressant. He said the medication at high doses can cause manic episodes.He suggested a different medication that is taken at bedtime.
Since then, I have had headaches, nightmares and am just generally feeling bad. THAT KIND OF BAD. I told my therapist Monday and she suggested talking to the doctor. I said no. She asked why and I told her I didn't like him, then I told her i thought he was indifferent. I am afraid he'll tell me to wait and see. or tell me that I should take what he suggested.
I understand the risks of taking the medications as I was. I am willing to take the risks. I am willing to have 1 or 2 less intense episodes a year. I don't want perfection, I don't want to go back to hell again.
How do I tell him I want my anti depressants back without appearing whiny, bitchy or critical?
I'm afraid I'll cry or start yelling or both if he says something I don't want to hear or he can't help.


ANSWER: Allie;

First, the doctor can't help if you don't discus things with him.   Secondly, is there another doctor available you may feel more comfortable with? It is necessary to be able to trust your doctor. You didn't mention the kind of medication you are on, the dosage or your "official" diagnosis. If you can give me that information, I can see what I might be able to suggest that the doctor might agree with.

In the meantime, check into possibly changing doctors if you don't feel comfortable with this one. You have every right to refuse medication you feel is not working. You must keep in mind-and yes, many doctors will try to intimidate you-that you know your body better than anyone. Speak up and let him know it isn't working.

If he feels the dosages were too high, ask if he has another medication that may work then.

         Joyce A. Anthony

---------- FOLLOW-UP ----------

QUESTION:   I have been diagnosed with rapid cycling bipolar disorder. My moods change quickly and violently. This is more likely to happen in the spring or fall.
 I take Wellbutrin 300mg in the morning, Trileptal 600mg twice daily, and Amiben 10mg for sleep as needed. I had been taking 450mg Wellbutrin until the second week of June. I also took Ativan .5mg until 5 or 6 months ago.
 I have tried Lexapro, Paxil, Tegretol, and Depakote. I have had other medications, but I cannot remember them.
 The doctor says Wellbutrin at high doses can actually cause episodes of mania. He suggested a medication that I could take at bedtime Symbyax? or Seroquil?
 I am honestly not sure if I don't trust my doctor or I don't trust my behavior at this point in time.

Answer
Allie:

Seroquel is definitely a good choice for rapid-cycling bipolar disorder.  You might discuss with your doctor the idea of stopping all current medications and replacing them with a combination of Seroquel and Lamictal--this combination seems to be working where no other medications have on rapid-cycling bipolar disorder.

         Joyce A. Anthony