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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest possible medication for bi-polar disorder

Sir, I am a Chartered Accountant from M.P. My wife Shraddha is patient of Bipolar Disorder. • 28 year old female • Known case of Bipolar disorder under treatment • After death of father Complaints of: flight of ideas, get distracted to odd things, vauge singing, loud music, seeing people/colour, irritation from inside, black magic, sleep difficulty without Oxazepam, confusion, mixing of 2 different things, negative towards relatives. Peviously first time had episode in 2006 between engagement and marriage. Was alright in 3 months of medication including lithium. No medicines since than. Now again in 2012 Medications form 5th July to 22 July Divalproex Sodium ER 1000mg, Paliperidone 6mg, procyclidine HCL 2.5mg twice, Oxazepam 30mg, Symtoms were under control after 5 days but had untolerable Extrapyramidal side effects and Dr. changed medicine to Medications from 22nd July to 2nd Aug. Thioridazine hydrochloride-10mg twice a day oxcarbazepine-300mg twice trihexyphenidyl hydrochloride-2mg zolpidem-10mg citicoline-500mg lorazepam-1mg propranolol hydrochloride-10mg alprazolam-0.25mg promethazine hcl-25mg But has some increased symtoms. 2 days before medicine change to Thioridazine hydrochloride-10mg twice a day oxcarbazepine ER-300mg thrice aripiprazole 10mg trihexyphenidyl hydrochloride-2mg citicoline-500mg lorazepam-1mg tri hexyphenidyl-2mg Still no relief to symtoms still quite less than intially had. but still have some episodes. 1) Should we switch either back to Valpoate or should start with lithium? 2) Vis-a-vis present medications what major side effect does lithium has? Can it be prevented or reduced by some medicines or precautions? 3) Is there any need of any health check up or tests? 4) Looking to the symtoms you please suggest about the current medications and is there any better medical help we can give. 5) Is the additional symtom of Confusion, mixing of 2 thing a side effect of any medicine or a symtom of bipolar. 6) How is elipsy different from bipolar. Looking to the history what you would diagnose. 7) Can we have a telephonic talk in regards to the patient. We will be obliged if you would share your phone No. and comfortable time of calling. Sir, your kind help would be a blessing for me and my family.
Fri, 14 Jun 2019
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Neurologist 's  Response
Hello,

First of all, you are switching the drugs rapidly and this is not a suitable way for the treatment.

You should take the drug regime for 6 months or until the symptoms are under control, then your doctor can reduce the dose of the drugs and you should continue the reduced doses of the drugs forever to prevent the relapse.

Second, Valproate Sodium can cause polycystic ovary disease, so this drug is not suitable for you.

Lithium is a good drug to treat bipolar disorder, but you should do kidney function tests, thyroid function tests and an ECG before starting taking Lithium and every month during the treatment with this drug.

Third, Olanzapine once per day and Fluoxetine 20 mg once per day is a good regime for a patient with a bipolar disorder and carbamazepine 400 mg is a good drug to prevent the relapse of the attack.

Hope I have answered your query. Let me know if I can assist you further.

Take care

Regards,
Dr Dr/Mustafa, Neurologist
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Suggest possible medication for bi-polar disorder

Hello, First of all, you are switching the drugs rapidly and this is not a suitable way for the treatment. You should take the drug regime for 6 months or until the symptoms are under control, then your doctor can reduce the dose of the drugs and you should continue the reduced doses of the drugs forever to prevent the relapse. Second, Valproate Sodium can cause polycystic ovary disease, so this drug is not suitable for you. Lithium is a good drug to treat bipolar disorder, but you should do kidney function tests, thyroid function tests and an ECG before starting taking Lithium and every month during the treatment with this drug. Third, Olanzapine once per day and Fluoxetine 20 mg once per day is a good regime for a patient with a bipolar disorder and carbamazepine 400 mg is a good drug to prevent the relapse of the attack. Hope I have answered your query. Let me know if I can assist you further. Take care Regards, Dr Dr/Mustafa, Neurologist