Posted by JohnL on September 26, 1999, at 8:24:13
In reply to lithium, posted by bob on September 25, 1999, at 18:14:06
> My 20 year old daughter has been diagnoised with bipolar disorder, and has been given lithium and paxil. I am concerned with the rush to medication and the type. I'm new to this-any advice?
Hi bob. You've come to the right place to learn more. This is a great site with many experienced folks with plenty of insight. If it's alright with you, I would like to share my non-professional opinions. I've been around the block a few times with these drugs and hope that sharing my experiences might be of assistance.
I think this is a harsh overly aggressive treatment at such an early stage of treatment. We don't know from your description the severity of the bipolar situation of your daughter. But because Paxil was mentioned, I am assuming the reason for consulting a doctor was depression.
You don't have to accept the doctor's prescription. If you are uncomfortable with it, tell him/her so. Ask for alternatives. If the doctor won't budge, politely thank them for their help and ask for time to think about it. Then, see another doctor.
If I may, I would suggest two possible alternatives that to me make a lot more sense. First, assuming the manic part of her bipolar is not severe, start with the antidepressant Wellbutrin. I say this because it has one of the mildest side effect profiles and also the least risk of inducing mania. ALL drugs, including Wellbutrin, Paxil, and even including mood stabilizers, can induce mania in some susceptible people. But Wellbutrin has a very low risk of doing that in comparison to other drugs. If insomnia or nervousness are troublesome side effects, a small dose of the antidepressant Remeron would prove very helpful in addition to the Wellbutrin.
Another strategy I would personally favor would be starting your daughter on Lamotrigine (Lamictal) or Gabapentin (Neurontin), and add an antidepressant later if it appears one is needed at that time.
Many arguments could be made in favor of, and against, Lithium as a first choice. Personally I don't like it as a first choice because it is a high-maintenance treatment with troublesome side effects. But to get some insight on how respected psychiatrists in this field deal with bipolar in this day and age, please check out the following places:
First, go to www.dr-bob.org/tips/ On the right hand side of the page go down and type Lamotrigine in the search field. Perform the search. It will provide a list of topics on the left side. Check out "Lamotrigine for Bipolar Disorder" first. Also check out "New Anticonvulsants in Bipolar Disorder", and "Choice of Mood Stabilizer".
Other good locations are www.psycom.net/depression.central.lamotrigine.html, and www.psycom.net/depression.central.gabapentin.html
I think it's very important to be comfortable with the doctor's prescription, to be well educated about the choices, and to have a doctor who will cooperate with you. It is a partnership in treatment. A team. Consider printing all the info you find at the locations I mentioned and bring them to the doctor. A second or third doctor is a good idea if the first isn't receptive to your research.
In summary, I do not like your doctor's prescription. In the end, it could be the treatment that works, but I absolutely do not think it is the place to start. Simpler is better. Try Wellbutrin first. Then consider Lamictal if needed. You came to the right place for research and I truly hope this will help steer you and your daughter in the right direction.
poster:JohnL
thread:12039
URL: http://www.dr-bob.org/babble/19990914/msgs/12066.html