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Behavior like bipolar disorder. Is there a hormone pill that can make her feel better? Weight gain after taking Prozac

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soon to be 16 yr old female behaves bi-polar like and was ruled out having such disorder. was in therapy in the past. bio-dad not in the picture. i know there are several contributing factors involved at this age; however, please tell me there is a hormone pill that can make her feel better and not cause a weight gain. she was on prozac, now on lexapro and still some days is so unhappy. i know at present, she just feels like giving up wth her diest again.
great student, working, good friends; however, does have locked up anger and i want her off all meds, but i know she needs something to take the edge off. also, i am a single parent! please advise...
Posted Sun, 22 Jul 2012 in Mental Health
Answered by Dr. Ashish Mittal 8 hours later
Thanks for your query.

I appreciate your efforts for medical consultation in so much distress.

Important aspects of your query are:
•     16 year old female
•     Treatment History: Prozac followed by lexapro
•     Complaints of: anger, bipolar like behavior, weight gain with medicines.

You case is interesting and but difficult too considering issues related to diagnosis and treatment. Even regular follow up with psychiatrist is not solve problem in many cases. I will try to give my best effort to help you in this problem.

You told that bipolar disorder is ruled out. In bipolar disorder patient used to develop manic or depressive episodes for few weeks. So, symptom remain constant for several days, which is absent in her case.

In her case she has more mood swing and impulsive behavior like excessive anger. Which frequently occur due to some personality traits. Prozac and Lexapro is used to treat depression and impulsive behavior.

I want to give information related to personality disorders so that you can understand the complexity of problem of your daughter, its assessment and concurrent assessment of psychiatric disorder during examination.

Definition: Personality disorders as enduring subjective experiences and behavior that deviate from cultural standards, are rigidly pervasive, have an onset in adolescence or early adulthood, are stable through time, and lead to unhappiness and impairment. When personality traits are rigid and maladaptive and produce functional impairment or subjective distress, a personality disorder may be diagnosed

Personality disorder subtypes classified in DSM-IV-TR are: schizotypal, schizoid, and paranoid (Cluster A); narcissistic, borderline, antisocial, and histrionic (Cluster B); and obsessive-compulsive, dependent, and avoidant (Cluster C).

Cluster A includes three disorders with odd, aloof features, such as paranoid, schizoid, and schizotypal.

Cluster B includes four disorders with dramatic, impulsive, and erratic features, such as borderline, antisocial, narcissistic, and histrionic.

Cluster C includes three disorders sharing anxious and fearful features, such as avoidant, dependent, and obsessive-compulsive.

Personality disorder is a common and chronic disorder. Its prevalence is estimated between 10 and 20 percent in the general population, and its duration is expressed in decades. Persons with personality disorder are frequently labeled as aggravating, demanding, or parasitic and are generally considered to have poor prognosis.

Personality disorder is also a predisposing factor for other psychiatric disorders (e.g., substance use, suicide, affective disorders, impulse-control disorders, eating disorders, depression and anxiety disorders) in which it interferes with treatment outcomes of other psychiatric disorder and increases personal incapacitation, morbidity, social complication and mortality of these patients.

Persons with personality disorders are far more likely to refuse psychiatric help and to deny their problems than persons with anxiety disorders, depressive disorders, or obsessive-compulsive disorder. Personality disorder symptoms are alloplastic (i.e., able to adapt to, and alter, the external environment) and ego-syntonic (i.e., acceptable to the ego). Persons with personality disorders do not feel anxiety about their maladaptive behavior. Because they do not routinely acknowledge pain from what others perceive as their symptoms, they often seem disinterested in treatment and impervious to recovery.

In last following measures will help you:

•     Personality assessment by clinical psychologist or trained psychiatrist. It may take several days to make final diagnosis. Following tests are used to assess personality which is administered by trained psychologist: Clinical interview, Sentence completion test, Rorschach Inkblot Test, Thematic Apperception Test (TAT), Minnesota-Multiphasic Personality Inventory (MMPI) and several other tests
•     Psychotherapeutic treatment after assessment in form of counselling +/- drug therapy.
•     Treatment of co morbid illness like: anxiety, depression or other problems.
•     Improvement used to take months depending on the case even irrespective of nature or intensity of treatment.
•     Get thyroid function test done in her case as its dysfunction can lead to anger and weight gain at this age (16yr).

Hope this answers your query.

Wishing you good health.
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