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Suggest treatment for bipolar depression

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Posted on Sat, 3 May 2014
Question: I am bipolar with chronic pain issues due to a serious car wreck.for two years I have been on latuda80,lamictal,topamax200,remrom45,trazadone200,lanesta3mg,valium1 5mg 2x daily if needed,same thing with lunesta,if needed,a fentanyl 25 patch oxycodone10 for breack thru pain. I have had a sleep study done to show how my heart rate and respirations are at night,hr 60,r.21, no time stopped breathing was told a perfect sleep. I feel awesome everyday,eat clean,drink 80 ozs of water,good supplements,exercise daily,am i ok on my meds, any need for concern?
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Answered by Dr. Abhishek Kapoor (1 hour later)
Brief Answer: Better to decrease benzodiazepine Detailed Answer: HI Thanks for using healthcare magic. I, Dr Abhishek Kapoor, would help you in this query. I think, you are a case of bipolar depression, thats why, you are on mood stabilizer and antidepressants. If you are a symptomatic, then it is ok. There are few need to change in the drug from my aspect. Lamictal and topamax are mood stabilizer, so carry on with them. Latuda is effective in bipolar depression, so you are take it. Remron and trazodone are sedative antidepressant, so you can also take them. There is no need to take benzodiazepine with such high dose of sedative antidepressants. Try to decrease valium and lunesta. These are benzodiazepine and with time tolerance may develop. You also take oxycodone and fentanyl as pain killer. These painkillers also increase sedative and drowsiness with benzodiazepine, so better to take them in lesser dose and then stop them. Rest, you can consult with your psychiatrist. In case, you need further help, you can ask. Regards Dr. Abhishek Kapoor Psychiatrist
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Abhishek Kapoor (2 days later)
I am a non smoker my pulse during sleep is 61 respirations 21, my oxygen level drops as low as 90, any need for concern with the oxygen? With my bipolar my norm is mania,making sleep very difficult, if I weaned off the 6:00 and 10:00 doses of valium,would I be safer with just taking lunesta? I still only average 6 hrs a night with it,without 3-4,predominately chronic pain issues awaken me frequently. My physichiatrist knows all the meds i am on ,he is not concerned for my safety at all.My pain clinic questions the need for any of my physc. meds. I never feel sedated during daytime hours. I am up at 6 am every day, active all day, and evening.My medications improve the quality of my life imensely.I have been on the same medications for the past 12 months,all but the lunesta 3mg,began 3 mths ago it has afforded me an additionally 2-3 hrs a night,also greatly improving my pain levels,my quality of life.Does the pain clinic need to be so concerened about my medications?
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Answered by Dr. Abhishek Kapoor (4 hours later)
Brief Answer: Nothing to worry about medication Detailed Answer: Hi Valium is benzodiazepine and it does not decrease oxygen saturation or oxygen level at such a low dose, so there is no need to worry about it. If you feel any sleep disturbance, then you can carry on with same dose of valium at night. If you want to take lunesta at night, the try to take it on sos basis. There is no need to take lunesta with valium regularly. It would help to avoid tolerance on lunesta. There is nothing to worry about oxycodone. Oxycodone can cause drowsiness or over sedation with valium, but everyone does not get such kind of side effects. In case, you feel such problem, then you can try to decrease dose of valium after your psychiatrist consultation. In case, you need further help, you can ask. Regards Dr. Abhishek Kapoor Psychiatrist
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Abhishek Kapoor

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Practicing since :2007

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Suggest treatment for bipolar depression

Brief Answer: Better to decrease benzodiazepine Detailed Answer: HI Thanks for using healthcare magic. I, Dr Abhishek Kapoor, would help you in this query. I think, you are a case of bipolar depression, thats why, you are on mood stabilizer and antidepressants. If you are a symptomatic, then it is ok. There are few need to change in the drug from my aspect. Lamictal and topamax are mood stabilizer, so carry on with them. Latuda is effective in bipolar depression, so you are take it. Remron and trazodone are sedative antidepressant, so you can also take them. There is no need to take benzodiazepine with such high dose of sedative antidepressants. Try to decrease valium and lunesta. These are benzodiazepine and with time tolerance may develop. You also take oxycodone and fentanyl as pain killer. These painkillers also increase sedative and drowsiness with benzodiazepine, so better to take them in lesser dose and then stop them. Rest, you can consult with your psychiatrist. In case, you need further help, you can ask. Regards Dr. Abhishek Kapoor Psychiatrist