Suggest treatment for bipolar disorder, depression, anxiety and borderline personality disorder

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Posted on Wed, 10 Jun 2015 in Brain and Spine
Question: My daughter has bipolar disorder, depression, anxiety and borderline personality disorder.
On Wednesday her psychiatrist ordered nefazodone. She woke up Thursday uncoordinated with slurred speech. She is still the same. She also takes Trazadone for sleep and recently put on Klonopin for anxiety. I am really scared as these symptoms are not going away. she shuffles severely and speech is very slow and deliberate. she is not confused. What do you think could be going on.

She describes the feeling as if there is a wall up between her brain and body. the things that are supposed to be natural like walking and talking she is trying hard to think about to make them happen.
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Answered by Dr. Dariush Saghafi 9 hours later
Brief Answer:
Overmedicated syndrome

Detailed Answer:
Good evening. My name is Dr. Saghafi and I am an adult neurologist. I have a number of patients who I consult on weekly who are sent to me with similar types of issues and it almost always comes down to overmedication issues.

I say this assuming that you are accurate in relating to me that there are no neurological deficits. In other words, she shows no signs of having suffered a stroke or has a tumor in her brain, etc. Certainly, in the way you presented the story it really points at medication being the most likely cause of her current problems.

As a neurologist, I can tell you that when dealing with overmedication issues causing either cognitive or physical deficits (i.e. thought processes seem slowed along with gait and speech disturbances) the best approach is to return the patient to the previous baseline by removing whichever medication tipped the scales. In this case, I would guess that the nefazodone would be the culprit. Therefore, the psychiatrist should be contacted and reported to as to what's going on in order to start working with them on either a slow weaning process or some other solution.

It's hard for me to understand why a patient would be on trazadone and nefazodone at the same time. That, in and of itself represents overmedication since they are 2 drugs from the same class. Klonopin on top of that combination can cause clear complications with cognition not to mention coordination and speech issues.

CONCLUSION: Your daughter needs a couple of things----

1. Get back to her previous mental and physical status baseline by realigning her medications to put her back to that place.

2. Once that happens then, I believe her psychiatric issues could be potentially helped with medication but a BETTER AND MORE LONG TERM solution (also likely to better address the root cause(s) of her psych issues) would be for her to be submitted for COGNITIVE BEHAVIORAL THERAPY (CBT).

3. Although psychiatrists are qualified to offer and perform such sessions....the fact is...most don't and depend on referring such patients out....it doesn't mean they have to lose the patient to someone else's care (such as a good psychologist or maybe neuropsychologist) but it is a more tedious process than just prescribing medication and that is the reason most psychiatrists would prefer not to go down this road.

I hope this answer satisfactorily addresses your interesting question. If so, may I ask your favor of a HIGH STAR RATING with some written feedback.

Also, if there are no other questions or comments, can I ask that you CLOSE THE QUERY on your end so this question can be transacted and archived for further reference by colleagues as necessary?

Please direct more comments and questions to me in the future at:

bit.ly/drdariushsaghafi and I would be honored to answer you very quickly and continue this interesting discussion.

Please keep me informed as to the outcome of your situation.
All the best.

The query has required a total of 25 minutes of physician specific time to read, research, and compile a return envoy to the patient.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Dariush Saghafi

Neurologist

Practicing since :1988

Answered : 2474 Questions

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