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Q: Would Like Son's Meds Changed - Possibilities?
My son is diagnosed bipolar 2 and is currently on effexor and abilify.
We have diabetes in the family, and my son is morbidly obese. In addition,
while he has been relatively stable until recently, he's been very depressed
lately and the meds don't seem to be working. By the way, I've had him on DHA
for years, and it is at least as effective as the pharmaceuticals. I want to
ask his dr. to change his meds...what do you suggest I research as
possibilities? Thanks.
Dear Pat --
1. Step one: there is a possibility that the Effexor is not only not working,
which is clear, but is contributing to "cycling", which could be the basis for
the recent depression. Therefore one option to be discussed with his
psychiatrist is whether slowly tapering Effexor should be part of the next set
of medication changes. This is controversial. His psychiatrist might not agree.
Some of the data relevant to this suggestion can be found on my page about
Antidepressant
Controversies: see the second controversy about
mood
destabilization.
2. After that, obviously one would be looking for a "mood stabilizer",
preferably one with antidepressant effects. See the
Mood
Stabilizer Options summary page for a list of current medications listed by
the quality of the evidence supporting their use. In the state of Texas, the
algorithm -- a recommended menu, and a recommended order in which to choose from
that menu -- begins with lamotrigine (Lamictal). High on that list are
quetiapine (Seroquel) and lithium. You will find on the mood stabilizer page
some information about aripiprazole (Abilify) showing that it too has some
antidepressant effects, although technically the data supporting its use in
bipolar depression are not quite as good as has been shown for some other
options.
You'll also see DHA (one component of fish oil) listed under the heading of
"randomized trials positive". In my experience, with the exception of one
possible patient, it has not been as effective as pharmaceuticals (by contrast,
however, several other non-medication modalities have been: light therapy in
particular, and exercise, and psychotherapy).
Good luck with the research.
Dr. Phelps
Published January, 2008
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