Expert: Ivan Goldberg, M.D. - 1/17/2006

Question
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Followup To
Question -
Hi,
I have bipolar disorder, and have been diagnosed and treated.  I have been really stable for the past two and a half years.  I have been doing well in multiple aspects of my life.

My problem is that I have a medicine issue that I can't seem to talk to my doctor about.  I am on Lithobid, which I take daily and never plan to go off of that.  Having said that, the next thing is going to sound horrible.  I have been prescribed Seroquel 100mg twice a day that I have not been taking.  At first I just didn't take the dose during the day because it caused me to be exhausted and unproductive.  Then I stopped taking the pm dose.  I still had side effects, and I really don't want to get Tardive Diskenesia.  If I get TD it can be irreversible.  I have not taken Seroquel for about a year.  Can the lithium be enough to keep me stable?

So, I know that it is bad that I am not taking one of my drugs for bipolar.  The thing is that I am really scared to tell my Psychiatrist.  He will probably be angry and not trust me anymore. He may insist that I go back on the drug or prescribe a drug that is just as bad or worse.  I suppose I could just start following my prescribed drug regimen and not say anything about the year of not taking it.

I am probably a psychiatrists worst nightmare because I have been so dishonest.  I would appreciate some advice.  I probably have an idea of what you are going to say.  So, hopefully once you say it I will have the guts to follow your advice.


Answer -
Hi, Maria . . .

I have many patients who have been maintained just on lithium . . . some since 1962 when we started to use lithium exerimentally.  So long as the lithium does a good job and does not cause kidney problems it can be amintained throughout one's life.

As for your problem regarding telling the doctor that you have not been taking the Seroquel . . . I'd tell the doctor and use what happens as a test of whether or not you should stay with that doctor or find a new one. If the doctro is unable to gracefully accept what you have done you need a new doctor.

Best regards . . .

Ivan
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Thanks for the prompt and professional answer to my question.  I know that you can't diagnose over the internet but I wanted to clarify a few things.  So, basically since I have been alright with out Seroquel this long I should continue to be alright without it?  Also, even though I was dishonest about going off the Seroquel the doctor should be able to accept it?  I am in my mid twenties finishing college for a professional program.  Is there anyway I could get in trouble for not taking all of the prescribed medicine?  Is there anyway the doctor could find out I am not taking Seroquel without me telling him? (I am wondering if he might somehow know already.)

If I do need to find a new doctor how do I go about doing it?  I really like that my current doctor does 20 min med check appointments, and 45-50 min therapy appointments if needed too.  I like having the option of having a longer appointment.  To find a new doctor do I just look in the phone book and start calling?  Or are there any kind of local referrals I can get?

Answer
Maria . . .

Medication (or medications) reduce the probability that someone with Bipolar Disorder will have future episodes. While they reduce the probability they do not guarantee that future episodes will never be expeienced, but they make it unlikely. The longer you go without an episode, the less likely you are to have future episodes.

You cannot get into any sort of triouble for not taking the medication.

If you need to find a new doctor, you can look at:
http://www.psycom.net/depression.central.psychiatrists.html
or ask your internist or gyn . . . I would not use the phone book.

Best regards . . .

Ivan
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