Posted by jane d on March 23, 2003, at 1:06:26
In reply to Mixture of Drugs/Comments Please, posted by hopko on March 22, 2003, at 13:18:06
> I am extremely worried about a friend who recently was released from the psych hospital in our community. I know she has been diagnosed as BP but I do not know her other specific illnesses. She was most recently admitted for suicidal thoughts. She gave me her list of current meds today and I am astounded at what she is taking and at the mixture of meds. I am asking for others opinions (either positive or negative) on her meds before I jump to any conclusions and advise her to seek help elsewhere. I must tell you she is extremely unstable and really needs some excellent help. Here is her list:
>
> Lithium: 300mg X2 a day
> Geodon: 40mg X2 a day
> Lamictal: 100mg X2 a day
> Klonopin: .5mg X4 a day
> Seroquel: 50mg X2 a day plus 300mg at night
> Trileptal: 150 a day
> Lexapro: 20mg a day
> Sectral: 200mg X2 a day
>
> I am interested to hear what any of you think. Thanks in advance.Hopko,
The number of meds is not in itself reason to assume she's not getting good treatment. Many doctors, especially non psychiatrists I think, are strongly opposed to using multiple drugs. There is this widely circulated story of someone suffering mild side effects from one drug, taking medication to counter those side effects, which in turn causes other problems for which another drug is prescribed, etc. In the end they are taking a dozen meds when they could just have replaced the first one. This is not necessarily what's happening here.
Prescribing multiple drugs is fairly common in psychiatry. No one knows exactly what goes wrong in all the various parts of the brain of someone with mental illness. And all of the drugs available work in more than one part of the brain so you get this situation where drug 1 is doing the right thing at points A and B, and the wrong thing at C, drug 2 does the right thing at A and C, nothing at B, and the wrong thing at D, drug 3 cancels the effect of drug 2 at A & D, etc, etc. And different from person to person too. No drug is precise enough to work at only one point, and even if it were we probably wouldn't know which point to choose.
It does seem like a long list, with some overlap, but there could be a reason for this. Lithium, Lamictal & Trileptal are mood stabilizers, Seroquel and Geodon are antipsychotics, Lexapro is an antidepressant, Klonopin a benzodiazepine and Sectral a beta blocker. All of these drugs can be prescribed to people with bipolar. It's pretty standard to take a mood stabilizer, antidepressant, and antipsychotic at the same time. It is not even unusual to take 2 drugs within one class such as two mood stabilizers. Different drugs within a class often don't have exactly the same effect (remember points A,B, &C) and sometimes a combination works better than either drug alone. She may also be in the process of switching to or from some of these drugs. Having an overlap period where you are taking both the old and the new drug at the same time is also fairly common.
It may be that your friend doesn't need all of these drugs but it could be that she does. And with bipolar, the risk to her if she stops taking a drug that she needs is probably greater than the risk from continuing to take a drug she doesn't need. Be very careful about suggesting to her that she is taking too many drugs. If you are really concerned, you can ask her instead if she has a psychiatrist that she is happy with, and suggest that she review all the drugs with her. If she doesn't have one she trusts, she needs to find one.
Jane
poster:jane d
thread:211470
URL: http://www.dr-bob.org/babble/20030319/msgs/211679.html