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Suggest treatment for Bipolar Depression with Alcohol abuse and seizures inspite of using Oxarbamazepine, lithium and Zolpidem

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Practicing since : 1983
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treating psychiatrist has been providing me with "professional samples" of EMSAM 6mg/24h: I am on certain prescribed meds including OXCARBAZEPIOOF (300 MG/1daily at nite) LATUDA (40 mg/I daily at nite) MAMMENDA XR (28 mg/1daily in am) ZOLPIDEMTARTRATE (10 mg/1 daily at nite) XANAX (1/2 to 1 every 4 hrs. as needed) lithium carbonate (300 mg/3 daily. My diagnoses include Major Depression; Mania; bi-polar. I am a frequent drinker of coffee, enjoy cheese: my alcohol consumption is social, meaning on a near daily basis use of beer or wine. My mood swings are now daily, very severe with strong ideation to suicide: I cannot concentrate on my work on a sustained or steady basis and as the result my work efficiency has dropped significantly and now I am especially sensitive to criticism of my work to the degree that I become enraged; will fly off the handle and must leave the work place to calm down. My driving is now getting worse and XXXXXXX to others and to myself as I "ignore real XXXXXXX situations on the roads especially at night time when driving home. I am 52 years od age, married with a good wife and two wonderful children-one in college and the other in a private prep school; my physical health is otherwise excellent with no diagnosed physical ailments excepting as noted above. Your advise please.
Posted Fri, 28 Mar 2014 in Mental Health
Answered by Dr. Saatiish Jhuntrraa 3 hours later
Brief Answer: Please talk to your doctor for medicine review Detailed Answer: Hello Thanks for choosing To sum up, you have Bipolar Depression with Alcohol abuse and H/O seizures. Your description suggests lots of impulsive behaviors . I think you need to review your medications . The dose of Oxcarbamazepine is very low , may need to be doubled with monitoring by serum level , lithium is a good choice but I am not sure of its effectiveness in rapidly cycling BPD as is your case so may be it could be tapered off, Emsam may be retained as it is good,effective and safe option, Zolpidem can be continued. I can suggest a few things 1- Please discuss with your doctor about your rage attacks- are they because of alcohol, untreated manic state or undiagnosed ADHD. 20% of patients of BPD have ADHD as comorbidity, which goes undiagnosed, resulting in poor response to medicines 2-Stop or reduce alcohol consumption 3-Please take medicines regularly My view would be to start you on Dipakote , to a maximum of 2 gm daily with serum level monitoring, then add lemitor as second mood stabilizer and slowly taper off all other medicines . Continue with Emsam, and screen you for ADHD. Any more query is welcome DR SAATIISH JHUNTRRAA
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