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Suggest treatment for bipolar disorder

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Posted on Fri, 9 May 2014
Question: I am on several meds and have been for a year now. I feel my mental health is declining and my doctor only wants to prescribe more meds. I'm depressed, have frequent panic attacks and have thought about harming others. I can't get into see another psychiatrist until the end of the month and if I go to the er they will admit me to the psych ward for 3 days then I'll be released. Could this problem be because of my meds? I am currently on ziprasidone 120mg, buspirone 15mg, zolpidem, 5mg xanex .25 (replaces ativan). I take all of these meds 1 x daily. I've been diagnosed with bipolar but don't believe this is acurate I forgot one...I also take lamotrigine 150 mg...that's it
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Answered by Dr. Srikanth Reddy (1 hour later)
Brief Answer: The medications not right for bipolar Detailed Answer: Hello, Thanks for choosing health care magic for posting your query. I have gone through your question in detail and I can understand what you are going through. If you have mentioned your diagnosis as bipolar, the according to me these medicines you are on at present are not appropriate. Ones you are diagnosed as bipolar, you certainly need to be on a mood stabilizer like Divalproex sodium or carbamazepine or oxcarbazepine etc. Lamotrigine is fine, but the ones which I mentioned have more proof of efficacy. Further it seems you are having a severe depression as well along with the panic attacks and buspirone is not the first line antidepressant to be used. In-fact escitalopram or mirtazapine should be a better option. Further the dose of zolpidem can also be increaed to 10mg if there is a persisting sleep problem as 5mg is a pediatric/geriatric dosage. Also if the depression and panic issues persist then it would be wise to take up cognitive behavioural therapy along with the medicines. This therapy is taken by either a psychologist or a psychiatrist in which the therapist identifies impaired cognitions (Thoughts) and try to correct them. They are 15-20 min weekly session and there should be around 8-10 sessions to help you with your illness. Do discuss these issues with your psychiatrist, who would be happy to do the above mentioned changes in your medicines. Hope I am able to answer your concerns. If you have any further query, I would be glad to help you. If not, you may close the discussion and if possible you may rate the answer for me, so that I get a good feedback. In future if you wish to contact me directly, you can use the below mentioned link: bit.ly/dr-srikanth-reddy Wish you good health, Kind regards Dr. Srikanth Reddy M.D.
Above answer was peer-reviewed by : Dr. Prasad
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Follow up: Dr. Srikanth Reddy (10 hours later)
Could any of these meds or lack of meds be the cause of my homocidal/suicidal ideations? Also, I am a little leary of xanax because I haven't heard good things about it. I have a lot of trouble sleeping and have tried ambian and ativan nothing seems to work so my dr prescribed xanax now. Like I said my main DX is bipolar and depression and anxiety but my meds are not helping at all, I feel like I am having a heart attack, can't breath, dizz. Sometimes I have racing thoughts, I am always sad and depressed. I get angry and offended easily. I also say what I think which offends people and gets them upset. Right now I am focused on a person that is talking about me and saying untruths. I can't seem to let it go.
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Answered by Dr. Srikanth Reddy (4 days later)
Brief Answer: Bipolar depression takes time to settle down Detailed Answer: Hello Thanks for the follow-up question and I am sorry for the delay in replying as there were some technical problems. I understand that you are suffering from bipolar depression with anxiety as i had mentioned in my first answer, the first line medications to this illness is a mood stabilizer. However in your case, lamotrigine is the only mood stabilizer that you are on and its not the first line drug. Meet your psychiatrist and get him to prescribe you either divalproex or lithium. Regarding xanax, you may take it as per the advice of your doctor and it is after all not such a bad drug. I have plenty of patients on this drug and they are all doing well. Regarding sleep, xanax may help you. Regards Dr. Srikanth Reddy MD
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Srikanth Reddy

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Suggest treatment for bipolar disorder

Brief Answer: The medications not right for bipolar Detailed Answer: Hello, Thanks for choosing health care magic for posting your query. I have gone through your question in detail and I can understand what you are going through. If you have mentioned your diagnosis as bipolar, the according to me these medicines you are on at present are not appropriate. Ones you are diagnosed as bipolar, you certainly need to be on a mood stabilizer like Divalproex sodium or carbamazepine or oxcarbazepine etc. Lamotrigine is fine, but the ones which I mentioned have more proof of efficacy. Further it seems you are having a severe depression as well along with the panic attacks and buspirone is not the first line antidepressant to be used. In-fact escitalopram or mirtazapine should be a better option. Further the dose of zolpidem can also be increaed to 10mg if there is a persisting sleep problem as 5mg is a pediatric/geriatric dosage. Also if the depression and panic issues persist then it would be wise to take up cognitive behavioural therapy along with the medicines. This therapy is taken by either a psychologist or a psychiatrist in which the therapist identifies impaired cognitions (Thoughts) and try to correct them. They are 15-20 min weekly session and there should be around 8-10 sessions to help you with your illness. Do discuss these issues with your psychiatrist, who would be happy to do the above mentioned changes in your medicines. Hope I am able to answer your concerns. If you have any further query, I would be glad to help you. If not, you may close the discussion and if possible you may rate the answer for me, so that I get a good feedback. In future if you wish to contact me directly, you can use the below mentioned link: bit.ly/dr-srikanth-reddy Wish you good health, Kind regards Dr. Srikanth Reddy M.D.