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Suggest Treatment For Bipolar Depression And Parkinson's Disease

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Posted on Tue, 9 May 2017
Question: I need second opinion on tretment bipolar depression and parkinson at the same time. I need opinion on 6 tablets that are taken for it and inspect possible interaction.
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Answered by Dr. Dr. Ashok Kumar Choudhary (29 minutes later)
Brief Answer:
Please share details of current symptoms

Detailed Answer:
Dear XXXX,
Thanks for using Healthcaremagic.

I read your query and understand your concerns.

Before I opine anything about the current treatment I like to know the current symptoms experienced by your father for which he is daignosed with bipolar depression and parkinson disease.

You must be having the records made by doctor. In case they are not available you can shoot a video showing almost all presentations pertaining to parkinson disease and bipolar depression. This will help me to judge the medication prescription in better way.

Regarding your conclusion about too many medications I agreee at this stage because he is experiencing side effects in form of nausea, vomiting and excessive salivation.

I look forward to assist you.
Thanks and regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Dr. Ashok Kumar Choudhary (32 minutes later)
Thank you for the pick up Dr. XXXXXXX XXXXXXX
I only can describe things you ask me because i dont have papers around me now. And will not have them for a while. Now, my father was diagnosed 10 years ago with bipolar depression. He used to have strong depressions (treated also in hospital) followed by mania phases that took months. First years before any treeatment took on positivelly on him (we needed to change medicaments few times as no good results apeared) depressions lasted say two months, followed by 2 months relativelly ok phase and then strong mania symptoms (money spending, aggression etc) for couple of months.. after I guess he started to take depakine chorono alongside with Mirtazen (but also was some time on Coaxil) and his symptoms have been nicelly subtled. The only phase we were more aware was depression state. It always took in autumn and father needed to seek hospital treatment (strong depression). This happend every other year. But was not followed by mania phases. And we were happy for that.. so we used to live with fact that from time to time a 75 year old father would probably fall into stronger depression and seek hospital "reset". That worked so far. 5 years ago he started with hand trembling and it was not treated until two years ago doctors diagnosed parkinson. Trmbling is now very strong and milder in other hand too. Father was not very disciplined with medication taking, but only 9 months ago we changed doctor (for parkinson) and he started to take Corbilta. As for parkinson my father suffer mostly tremor (hands), and slowed movement. And it got worsened. He does not suffer from loss of posture or balance. No speech changes. Doctor says father had to be treated sooner and that level of corbilta will step by step needed to be increased so we have to wait I guess. I am surprised my father needs to take also nimvasted and quetiapine with quetiapine being antipsychotic and more receptor (even dopamin) anragonist - i remember that doctors had some speculation over if father does not exert also some alzhaimer symptoms but i do not believe, but i am affraid doctors (not the one specialist for oarkinson but rather doctors from hospital) add those pills just for the sake of treating/subtling the symptoms in any fashion.
doctor
Answered by Dr. Dr. Ashok Kumar Choudhary (12 minutes later)
Brief Answer:
Follow up

Detailed Answer:
Dear XXXX,
Thanks for follow up and sharing details.

In my opinion rivastigmine is just add on therapy and have little role in either parkinson or bipolar depression.
livation
In addition I lie ke to make it clear that cognitive symptoms do present in both parkinson as well as bipolar disorder. I do not think diagnosis of alzheimer disease is based on simple guess and no medicine should be prescribed unless there is clear evidence of dementia independent of other disgnosis.

I agree with their opinion to increase parkinson medication as excessive salivation is not a prominent side effect of any of the current medications except seroquel ( provided the dose is 150 mg or more) and most likely parkinson symptom.

In case the dose of seroquel is high an attempt should be made to decrease dose of it with hope that salivation will decrease otherwise parkinson medication should be increased.

I hope this answers you.
If you have more questions feel free to write back to me.
Thanks and regards.


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Dr. Ashok Kumar Choudhary (3 hours later)
Usually my father got depression phase when he stopped taking antidepresive pills or just underdosaged himself, or even when for some uknown reason to me his doctor changed the prescription, usually after my dad raised issues he can not sleep or that he is nonstop tired etc. But id did alwas happen for some extraordinary reason. But in general he was stabilised. With parkinson i am aware of corbilta or other levodopa based pills. So we wait what helps his tremor... But i am affraid that nimvastid and quetiapine is on top of the others , trying to treat symptoms more of dementia which i dont see in any significant presence - he still has good memory, never lost himself, talks politics.. I am not taking into account incontinencia, vomiting, naussea, salivating and therefore some anxiety or annoyence, even if in depression as any sign of demencia. I read something about dementia but it does not look to me he has to be treated for it. Ican not tell more as i do not have papers with me why quetiapine, nimvasted and when they have been introduced.
doctor
Answered by Dr. Dr. Ashok Kumar Choudhary (41 minutes later)
Brief Answer:
Follow up

Detailed Answer:
Dear XXXX,
Thanks for follow up.

I think all these issues need to bring under discussion on the next visit. As communicated above I am not convinced with diagnosis of dementia and in favor of removing rivastigmine.

I understand that depression could be present in dementia but he is having depression for last 10 years and this simple fact can not be ignored.

I hope this answers you further.
If you have any further query, I would be glad to help you.
If not, you may close the discussion and if possible you may rate the answer for my future patients.
In future if you wish to contact me directly, you can use the below mentioned link:
http://doctor.healthcaremagic.com/doctors/dr-ashok-kumar/67386
Thanks and regards.
Note: For further guidance on mental health, Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Dr. Ashok Kumar Choudhary

Psychiatrist

Practicing since :2000

Answered : 3347 Questions

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Suggest Treatment For Bipolar Depression And Parkinson's Disease

Brief Answer: Please share details of current symptoms Detailed Answer: Dear XXXX, Thanks for using Healthcaremagic. I read your query and understand your concerns. Before I opine anything about the current treatment I like to know the current symptoms experienced by your father for which he is daignosed with bipolar depression and parkinson disease. You must be having the records made by doctor. In case they are not available you can shoot a video showing almost all presentations pertaining to parkinson disease and bipolar depression. This will help me to judge the medication prescription in better way. Regarding your conclusion about too many medications I agreee at this stage because he is experiencing side effects in form of nausea, vomiting and excessive salivation. I look forward to assist you. Thanks and regards.