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Depression, anxiety,Hepatitis C, Cirrhosis, side effects of bi-polar disease medication - Online Doctor Chats

Date : 21-Feb-2012
User rating for this question
Very Good Posted in: Bipolar Disorder
Answered by

General & Family Physician
Practicing since : 2009
Answered : 674 Questions
Doctor :   Hi
Doctor :   How can I help you?
User :   Hello. I have a question about Depression, more exactly the condition of Bi-Polar
Doctor :   Proceed.
User :   My twin sister is 34 year old. She has been battling with Depression, Anxiety for ten years now.
Doctor :   Ok
User :   She takes Zoloft 100 mg, Sobril 10-20 mg, Lergigan 200 mg
Doctor :   Ok
User :   Has also beein diagnosed with Hep C and Cirrhosis two years ago
Doctor :   Ok
User :   She's 180 cm tall, weighs 74 kg. Has lost 50 kg and has had the same weight, 74 kg for two years now
Doctor :   Ok
User :   She is very bitter, belligerent, easy annoyed
User :   How does a physchiatrist, therapyist diagnose a patient with Bi-Polar
User :   what are the signs, symtomps and treatment for it?
Doctor :   A few diagnostic criteria have been formulated and named as DSM criteria have been used by clinicians.
Doctor :   These criterias are used to name a person with psychiatric illness.
Doctor :   The clinical symptoms of bipolar disorder are varied.
User :   Her mood is up and down. Very negative, combative, no sense of stability. Pessamistic. Her physciatrist says that before she prescribe her other anti-depressives, she has to undergo treatment for her Hep C and get it out her system.
Doctor :   In general a person with bipolar disorder are depressed most time mixed with spells of hyper irritability and impulsiveness.
Doctor :   The drugs used for its treatment have affects on liver functions.
Doctor :   And they could impair / worsen liver functions.
Doctor :   Hence this problem needs to be monitored by a gastroenterologist.
Doctor :   You may consult a gastroenterologist who by means of regular liver function tests and scan keep a watch on the liver conditions while being on the anti depressants.
User :   I see.
Doctor :   The drugs can be reduced or stopped if the liver functions start to deteriorate.
Doctor :   Do you follow?
User :   So my sister should not take drugs for bi-polar before the Hep C is out of her system, or she can but be highly monitored by her gasroenterlogist?
Doctor :   Hepatitis C treatment has been evolving.
Doctor :   Earlier, Hepatitis C was equally dangerous compared to other chronic infections.
Doctor :   However the times have changed.
Doctor :   Though it may be difficult to completely get the Hepatitis C completely out of the system, with adequate antivirals / interferon or other adjuvant medications, the infection can be kept under control.
User :   Yes she has told my sister that. Fortunately there has become a break-through and the pills and shots she will be administered with be fore six months.
Doctor :   The need for such drugs are often decided by a gastroenterologist who is constantly watching and monitoring the liver status.
Doctor :   So my answer to your question is, it might be difficult to
Doctor :   get the infection completely out of the system.
Doctor :   The pro and cons of the anti depressant medications are to be considered
Doctor :   both by the gastroenterologist and psychiatrist
Doctor :   accordingly the need for medications can be decided.
User :   Well my sister's liver function is good, her blood tests are very good and they have also checked inside her with a tube camera and everything looked great
Doctor :   If the liver functions are good and if anti depressants are really essential, then I would consider it in small dose while I monitor the liver functions frequently.
Doctor :   If I find the functions deteriorating, then I would stop the medications.
Doctor :   It is very essential and highly important that such treatment is done under guidance of a gastroenterologist
Doctor :   who can keep a close watch on the liver.
Doctor :   Hope it is clear to you.
Doctor :   Do you have any other query?
User :   are there any side-effects to the treatment of Hep C when it comes to her mental and emotional state
User :   wil it worsen?
Doctor :   There are no clinical studies that show mental and emotional changes which are directly caused by antiviral drugs/interferons.
Doctor :   BUT, antidepressant medications can significantly affect liver condition.
Doctor :   Do you follow?
Doctor :   Do you have any other query?
User :   yes
User :   i understand.
User :   what are the best medications for bi-polar?
Doctor :   Various drugs have been used in the treatment of bipolar disorder among which the most commonly used ones are
Doctor :   1. Lithium
Doctor :   2. Group of anticonvulsant drugs.
Doctor :   3. Antipsychotic drugs
Doctor :   4. Antideprassants belonging to the class of SSRI's
Doctor :   MAO inhibitors/tricyclic anti depressants.
Doctor :   5. Some doctors use calcium channel blockers in some patients.
Doctor :   6. Sedatives such as benzodiazepines.
Doctor :   Often combination of these drugs are used for proper control of the symptoms.
User :   Another question is this, she is curently taking is Zoloft, Lergigan, Sobril but still feels very bad. Impulsive, highly sensitive, can cry at the drop of a hat and quarrell in the next moment. Her mood is up and down.
User :   Does that mean that the anti-depressants do not work for her or are unsuitable?
Doctor :   The effectiveness of the drugs can reduce in some individuals over a period of time, due to drug tolerance and other factors.
Doctor :   Siting from this far without being able to evaluate your sister, I am unable to suggest what is the next appropriate step.
Doctor :   Hence I encourage you to consult her pyschiatrist, off course in collaboration with a gastroenterologist.
Doctor :   The next steps of management will be decided by them.
Doctor :   She may need dose adjustment if her liver is tolerating the medication well.
User :   She has both. She and I are very close and I'm very concern for her. I can't see her feeling so bad and crying. She's not the same person.
Doctor :   I can understand your concern. Since she is found to have cirrhosis, the choice of medications are limited.
Doctor :   Any new medications that may be started can be done only after the consent of the gastroenterologist.
User :   She has been diagnosed with Hep C, Cirrhosis, Depresstion, Anxiety, Post Traumatic Stress. I'm not sure if her pyschatrist has diagnosed her correctly or if she has been given the right drugs for her sickness
Doctor :   Zoloft is a SSRI, Sobril a benzodiazepine, and Lergigan also have sedative effects. These drugs are good choice of medications in the treatment of depression.
User :   i understand
Doctor :   Hope I have answered your query.
User :   about this DSM
User :   can it accuretly diagnose a patient with mental illness?
User :   because they want to change her medicine after the Hep C is out of her system, then they must know that they are not working for her un unsuitable?
Doctor :   A patient is named bipolar when there are episodes of hyper irritability and impulsiveness in the background of depression.
Doctor :   The DSM criteria was formulated by
Doctor :   the American Association of Psychiatrist
Doctor :   and is widely used by clinician
Doctor :   in the diagnosis and grouping of bipolar disorder.
Doctor :   I am sure, your psychiatrist is also using these diagnostic criteria's in managing her condition.
User :   so they diagnose by clinical history, genes, symptons, mental/emotional state?
Doctor :   The clinical history is the predominantly used features - the symptoms, the number of irritable (maniac) episodes occuring, frequency of such spells are featured in the DSM criteria.
Doctor :   Do you follow?
Doctor :   Do you have any other query?
User :   i see
User :   my sister has a appointment with her psychiatrist 27:th of June
User :   what do you think I should do.
Doctor :   Treatment is usually gradual and slow.
Doctor :   Since the liver problem will be affecting in the treatment plans,
Doctor :   the doctors may be using the medication in suboptimal doses.
Doctor :   Apart from the medications psychosocial treatment such as CBT is important.
User :   suboptimal does, you mean Lergigan, Zoloft and Sobril?
User :   or in general?
Doctor :   I will rephrase that statement.
Doctor :   The dose and the choice of medications will be strongly determined by the current liver status.
User :   please
Doctor :   The dose of zoloft varies between 25 to 200mg per day.
Doctor :   while the doses of sobril and lergigan is fine.
User :   ok.
Doctor :   The pros and cons of increasing the dose or addition of new drugs such as another antidepressant will be based on the liver functioning.
User :   i see. May I ask you another question
Doctor :   Proceed with your query.
Doctor :   Are you there?
User :   She was prescribed by her house doctor Levazin for her thyroid. Her levals were 5, instead of 3 which is the normal leval they say. She stopped taking them
Doctor :   How long ago did she stop the thyroid supplements?
User :   she stopped taking them. When she stopped, she tells me that her glands are swollen.
Doctor :   Swelling of the thyroid gland is termed as goitre.
User :   2-3 years
User :   ago
User :   25 mg of Levaxin
Doctor :   and it could be related to low thyroid hormone level.
Doctor :   If the swelling is not very large, correcting the swelling is only for cosmetic purpose.
Doctor :   However, I do not think it is a good idea to be off thryoxine(Levoxine)
User :   is it dangerous or harmful. Should she takethem again. She stopped getting her period 3 years ago
Doctor :   Low thyroid hormone (hypothyroidism) could be contributing to the depressive symptoms.
Doctor :   Hence I suggest that apart from the liver functions, thyroid function is also checked.
Doctor :   If the TSH levels are above normal, then hormone supplements is very, very essential.
Doctor :   Do you follow?
User :   I think so. Her house doctor hasn't checked her thyroid since 2-3 years ago. Her levels were, like I mentioned before 5
Doctor :   If the levels were checked 2-3 years ago, then I think it is high time that the levels are checked now.
User :   They should check her thyroid again and if needed take the pills again, correct?
Doctor :   yes, if the levels are abnormal, the correction is essential.
User :   i agree. Could it contribute to her mental and emotional state?
Doctor :   Low thyroid hormones are known to cause depressive and mental symptoms.
Doctor :   The other symptoms associated with hypothyroidism are dry skin, obesity, menstrual irregularities, intolerance to cold and so on.
Doctor :   so it could be possible that if not all some of her mental and emotional symptoms could be due to low thyroid hormones.
Doctor :   No, sexual activity do not influence hormone levels.
User :   Another question. She is still a virgin can the hormones be affected by that fact?
Doctor :   The cause of hypothyroidism is not found in many patients. It is usually associated with genetic factors.
Doctor :   Low iodine intake, infections, autoimmune disorders are few other causes of hypothyroidism.
User :   Well I take Levaxin for 3-4 years now and we are twins
Doctor :   Genetic conditions have been linked with hypothyroidism in many cases.
Doctor :   It is probably the genes that could be the cause here. So checking the hormone levels is necessary.
User :   i understand. so what levals should she have thyroid
User :   how about high levals of thyroid?
Doctor :   With regards to emotional and mental symptoms,there is considerable overlap in both the conditions (low and high thyroid levels).
Doctor :   However the other symptoms are contrasting.
User :   such as
Doctor :   I mean, hyperthyroidism is associated with palpitation, tremors, perspiration, underweight, heat intolerance.
Doctor :   menstrual abnormalities are also found in hyperthyroidism.
Doctor :   Since your sister had hypothyroidism in the past and is off medications for long while,
Doctor :   there is high chances of hypothyroidism.
Doctor :   Consider getting the thyroid function tests.
Doctor :   Are you there?
Doctor :   Do you have any other query?
User :   ok i see.
User :   let me think
Doctor :   My pleasure.
Doctor :   Thanks for consulting me.
User :   THANK YOU KINDLY!!!!!
Doctor :   Bye for now.
User :   youre welcome
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