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Suggest Ways To Manage Anger And Mood Swings When Diagnosed With Bipolar Disorder

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Posted on Mon, 2 Mar 2015
Question: Hello,
My almost 17 year old son has finally been diagnosed (after struggling for 3 years and dangerous effects of 3 different SSRI's). He was hospitalized for 3 months - finally we got care - this past fall - out Dec 18, 2014. XXXXXXX is very sensitive to medications. He had EPS when we tried Abilify; very scary. Then they tried Seroquel which when increased from 100-150mgs we saw extreme out of control anger; extremely sedative and unrecognizable as our normally positive, social, kind, intelligent and sporty son. Also he didn't sleep. Then we tried Limotrigene. It took awhile but we have the seen the most improvement yet. He is on 200mgs. BUT with the increased dosage, he has developed bad acnes and cyst like lumps on his face. Also and more troubling, about 6 weeks out after hospital, he had a 3-4 day period where he felt suicidal and couldn't go to school for a presentation that he was prepared for. Then he came out but we were worried. Wellbutrin 100mgs was added. 1.5 weeks later another low but not quite as low - though still suicidal thoughts. We saw his psychiatrist and decided to increase to 150mgs of Wellbutrin. But again over the past week he became very suicidal in his thinking - we were worried he'd have to go to youth psych emerg.. He now had 2 nights of no sleep and became anxious++; also lack of appetite and nausea on eating , plus extremely andgry andpunch a hole in the wall. We saw the psychiatrist again who was resistant but agreed to discontinue the Wellbutrin. Our goal had been if this had worked well, we could have decreased the Limotrigene to deal with the skin. She has now suggested we try lithium ... slowly titrate up and possibly reduce Limotrigene if we can. (Also we added back in 2.5mgs of Olanzepine and he has slept. So we will probably go back to 50mgs Trazedone tonight.) OR possibly add to Limotrigene: Prozac, Cipralex (both of which at higher doses that 5mgs on their own caused him to feel worse) or perhaps Asenapine or Lurasidone - both of which look scary to me. I am a psychotherapist in private practice - now working for 16 years, so I have been able to advocate for my son better than many .. but this is still so worrying. Graeme's major issue is the depression though when hypomanic he gets angry and agitated. Whatever can be helpful for our upcoming discussions with the doc would be most helpful. She has suggested I do some research which I have. XXXX


I am sorry - I didn't include the diagnosis of Bipolar type II which includes from what I can see, rapid cycling.
doctor
Answered by Dr. Chintan Solanki (1 hour later)
Brief Answer:
ECT is the best option to control suicidal thoughts

Detailed Answer:
Hello XXXX,

Thanks for writing to us.

You have very well narrated your son Graeme's history.

Bipolar II is naturally going to worsen with SSRi given alone for depression without cover of mood stabilizer.Same had happen in his case when he was given cipralex and prozac.

Lamotrigine and lithium are both good mood stabilizer drugs. If lamotrigine is causing skin problem,Lithium can be used and titrated gradually as suggested.Lithium is the only drug with proven anti suicidal effect.No need of prozac or cipralex when lithium is used.

Even if lithium not suits him by chance sodium valproate/divalproaxe sodium is also a good option.

Short term use of olanzapine is also useful to calm down anger.

In my opinion to control his suicidal thoughts Electro Convulsive Therapy (ECT) is the best option. It will also help to reduce episodes of anger.After successful course of ECT he should continue the lithium under doctor's guidance.

Hope I have answered your query, I will be happy to help further.

Regards,
Dr.Chintan Solanki
Note: For further guidance on mental health, Click here.

Above answer was peer-reviewed by : Dr. Prasad
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Answered by
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Dr. Chintan Solanki

Psychiatrist

Practicing since :2007

Answered : 2406 Questions

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Suggest Ways To Manage Anger And Mood Swings When Diagnosed With Bipolar Disorder

Brief Answer: ECT is the best option to control suicidal thoughts Detailed Answer: Hello XXXX, Thanks for writing to us. You have very well narrated your son Graeme's history. Bipolar II is naturally going to worsen with SSRi given alone for depression without cover of mood stabilizer.Same had happen in his case when he was given cipralex and prozac. Lamotrigine and lithium are both good mood stabilizer drugs. If lamotrigine is causing skin problem,Lithium can be used and titrated gradually as suggested.Lithium is the only drug with proven anti suicidal effect.No need of prozac or cipralex when lithium is used. Even if lithium not suits him by chance sodium valproate/divalproaxe sodium is also a good option. Short term use of olanzapine is also useful to calm down anger. In my opinion to control his suicidal thoughts Electro Convulsive Therapy (ECT) is the best option. It will also help to reduce episodes of anger.After successful course of ECT he should continue the lithium under doctor's guidance. Hope I have answered your query, I will be happy to help further. Regards, Dr.Chintan Solanki