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Suggest Treatment For Depression And Severe Mood Swings While Having Bipolar Disorder

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Posted on Sat, 5 Aug 2017
Twitter Sat, 5 Aug 2017 Answered on
Twitter Mon, 4 Sep 2017 Last reviewed on
Question : my husband has bipolar 1 (I think it's 1) disorder, and has for 30 years, from what he's told me. we've only been married 3 years, I'm still learning about the disease. From what I've read and been told by spouses of bipolar people, most with medication are normal and only have rare episodes. My husband has been treated by the same psychiatrist for 30 years. Here's what I don't understand. My husband, we'll call him XXXXXXX has NO NORMAL. He's either manic or depressed. The depressed used to last a lot longer than the manic, with the depression being weeks or months and manic being days or a week. Then it flip flopped, almost exact opposite. Now, I'm not exactly sure but he's been depressed for over a month. Which means he goes to work, usually, then home and straight to bed. Sometimes he gets up to eat, sometimes he won't but it's always right back to bed. He is either manic or depressed, there is never any normal. Until this past year, I didn't realize he should have normal, since I have, I try to talk him into a new doctor. It seems to me that after 30 years the guy could get his medicine right, they have played around with it, no success. When his doctor changes it, he reschedules him for 3 months, I may be wrong, but with a case this severe and experimenting with the medicine on top of that, seems to me that he'd want to see him more often. Also, I thought he was meaner when he was manic, but then I realized that too is also different every time. It's almost like he has no medicine. And yes, he does take his medicine. His last manic episode, he spent $11,200.00 in just about a month, then borrowed $10,000.00 more and went through it in the same length of time without paying any bills. It is very, very disruptive and extremely hard to live, we can't keep any money in savings. He doesn't like to talk about it, it's almost as if he thinks I'm putting him down when I try to talk to him about getting help. He doesn't want anti psychotics, says he can't function on them, makes him "out of it" wakes up and doesn't know where he's at... any ideas? How can I find a doctor whose an expert in this field? thanks, Mrs. XXXXXXX XXXX
His list of medications:
Vraylar (cariprazine) capsules 1.5 mg per capsule: 1 capsule every evening
Atorvastatin Tabs 20 mg: 1 tab daily
Lamotrigine Tabs 200 mg: 1 tablet at bedtime
Losartan Tabs 100 mg: 1 tablet daily
Lithium Carbonate Caps 300 mg: 1 capsule at bedtime
He just asked his doctor for the Lithium, so the doctor added it to what he already had instead of taking anything away. I'm no doctor but if these aren't working at all, why keep them? It's my understanding that my husband was on Lithium for 30 years, he asked to get off it because of the severity of shaking in his hands. I didn't know him until he'd just gotten off of it, but from what I've heard, he's been the same for years, as far as the mood swings. Sometime's when he's manic he is extremely mean, it's gotten worse, he actually spit in my face during his last episode. He constantly gripes at me for things not being up to his standards, but I do things exactly how he wants, it doesn't matter, there's always something wrong with it. I know he is sick, but it's really taken a toll on my self esteem. He has caused his daughters to hate me, there in their 30's, by the way. I have an 8 year old daughter and I don't want this to adversely affect her, she lost her father a year ago. When my husbands manic he usually pays attention to her and asks her to go to the store with him and help him clean the garage, which she just loves helping him. Seems like she tries so hard to get on his good side, but when he's depressed, all he does is gripe about everything that's wrong. I've told him there has to be good with the negative, and I always tell him to back off her,unfortunately, she's already heard it. She acts like it doesn't bother her, but I think it'd have to, especially the going back and forth from talking to her and taking her to the stores when he goes, which can be several times a day, to being in bed all the time and the few minutes he does surface, he's never nice, only complaining about all the stuff she's doing wrong. Please, I love my husband, I know he can have normal, can you help me figure out how to get it for him? Also, he took me off and on our account at the bank about 5 times, until now, I'm off it completely, therefore I can't keep him from blowing the everything in his account, and he never pays the bills, so when I realize it, were stuck with everything being 3 to 700 dollars behind and disconnect notices.
Really, really want to get him to the normal I hear so much about, everyone assumes he can't be taking his meds, but he does.
Also, maybe generic is not the answer, I know they don't work for me and some others I know.
If you could refer me a good doctor, I'd greatly appreciate it. We live in XXXXXXX Indiana 47446
Thanks for everything,
Mrs. XXXXXXX XXXX
doctor
Answered by Dr. Seikhoo Bishnoi (37 minutes later)
Brief Answer:
Doses of drugs can be increased.

Detailed Answer:
Hello thanks for asking from HCM

I can understand your problem. He is suffering from Bipolar Affective Disorder and as you know this is a mood disorder. The individuals have episodes of mania or mania and depression. With time as the disorder becomes chronic rapid shifts in mood are seen and this is the reason he is becoming manic for few days and then depressed.

In most cases the reasons for poor response are inadequate doses, poor compliance to treatment and poor family support. He has great support so we should focus in former two.

His current therapy has Cariprazine, Lithium and Lamotrigine. The dose of Cariprazine is good but considering his chronic nature of illness doses of Lamotrigine and Lithium are not adequate.

He is on 300 mg lithium and at this dose the drug will not have any effects. Lithium follow therapeutic window phenomenon and doses should be in adequate range. You can get his serum lithium levels done and most likely these will come below 0.6 which is the lower range. The dose should be increased to at least 300 to 900 mg per day. This will result in proper mood stabilization. For depressive symptoms Lamotrigine can be increased to 400 mg a day. This dose adjustment will help to control his mood swings. You can talk with his doctor for these dose changes.

If he refuse to take increased doses then he can be given depot long acting antipsychotic injections. These are safe and better tolerated. Risperidone consta or Haloperidol deconate can be used. Long acting drugs will not impair his day to day functioning. These are safe and have only few side effects.

So please talk with him and then with his doctor for the options I have mentioned.

Regarding psychiatrist in your area you can search in "Doctors" section and can take appointment.

If you need more assistance then please let me know.

Thanks and Take care
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. Seikhoo Bishnoi

Psychiatrist

Practicing since :2007

Answered : 5192 Questions

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Suggest Treatment For Depression And Severe Mood Swings While Having Bipolar Disorder

Brief Answer: Doses of drugs can be increased. Detailed Answer: Hello thanks for asking from HCM I can understand your problem. He is suffering from Bipolar Affective Disorder and as you know this is a mood disorder. The individuals have episodes of mania or mania and depression. With time as the disorder becomes chronic rapid shifts in mood are seen and this is the reason he is becoming manic for few days and then depressed. In most cases the reasons for poor response are inadequate doses, poor compliance to treatment and poor family support. He has great support so we should focus in former two. His current therapy has Cariprazine, Lithium and Lamotrigine. The dose of Cariprazine is good but considering his chronic nature of illness doses of Lamotrigine and Lithium are not adequate. He is on 300 mg lithium and at this dose the drug will not have any effects. Lithium follow therapeutic window phenomenon and doses should be in adequate range. You can get his serum lithium levels done and most likely these will come below 0.6 which is the lower range. The dose should be increased to at least 300 to 900 mg per day. This will result in proper mood stabilization. For depressive symptoms Lamotrigine can be increased to 400 mg a day. This dose adjustment will help to control his mood swings. You can talk with his doctor for these dose changes. If he refuse to take increased doses then he can be given depot long acting antipsychotic injections. These are safe and better tolerated. Risperidone consta or Haloperidol deconate can be used. Long acting drugs will not impair his day to day functioning. These are safe and have only few side effects. So please talk with him and then with his doctor for the options I have mentioned. Regarding psychiatrist in your area you can search in "Doctors" section and can take appointment. If you need more assistance then please let me know. Thanks and Take care