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Suggest Treatment For Erratic Behavior, Signs Of Isolation, Irrational Anger And Paranoia

Posted on Thu, 11 Jun 2015

Question: My wife has depression, anxiety, and alcohol abuse and is being treated with lexopro(100mg), wellbutrin (300mg), vistoril (50mg), and abilify (2mg) by her psychiatrist. I have not been allowed into her sessions even though I want to be present. Her condition has not improved or stabilized, it has only spiraled out of control. In response, her prescription has only been increased in dosage amount. She is exhibiting irrational behavior, paranoia, lying, irrational anger and I have gone from her soul mate to her worst enemy without provocation. She is showing signs of isolation and erratic behavior. I love my wife unconditionally. This is not the woman I have known for 11 years. I believe the medication is altering my wife's behavior and putting our financial and romantic future in potential jeopardy. Is it possible for her to cease the medicine immediately without any negative side effects or should she be tapper-ed off over time? I plan to get a second independent consult for my wife as I doubt the competency of her current treating physician. I just hope my wife isn't so irrational that she fails to trust me. She is my world. Thank you for your time and any guidance you can provide.

Answered by Dr. Shubham Mehta (1 hour later)

Brief Answer:
probable psychosis; change of drugs needed.

Detailed Answer:
Hello
Welcome to HCM.
I understand your concerns for your wife.

As per your description, first thing which strikes to my mind is appropriateness of her treatment.

She has been diagnosed with depression, anxiety and alcohol abuse. She is being given lexapro (100mg???..did you really meant to write 100mg or its just a mistake..the maximum dose of lexapro is 20-30mg), wellbutrin, vistaril and abilify.

But you have mentioned her prominent symptom to be irrational behaviour, paranoia, lying and anger and suspicion over you.

I think its not just depression and anxiety.
It is more suggestive of psychosis.
The drugs indicated in such cases are antipsychotics like olanzapine or risperidone (prescription drugs).
However, a detailed examination a psychiatrist is must.

The medications, if stopped suddenly, will cause withdrawal symptoms. Ideally, the drugs have to tapered slowly.
Also, change of drugs is must in her case before there is florid difficult-to-treat psychosis.

I would strongly suggest you to take a second opinion from a psychiatrist.
You can discuss my suggestions with him and proceed accordingly for the best treatment of your wife.

Hope I am able to address your concerns satisfactorily.

Feel free to ask further.

Thanks.
Dr. Shubham Mehta, MD(Psychiatry).

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Shubham Mehta (2 days later)

Thank you. I was mistaken as to her dosage of lexapro at 20 mg. when she forgets to take the medication in the morning, she is irrationally angry/easily upset early morning or begins to show signs of more like the person I know if longer time goes by, when I ask her at that time if she truly wants a divorce she says no, but about 2 hours after taking it. As the day progresses and i voice my concerns about her behavior and relationship with the pills she dismisses them that I am crazy. I am very concerned for her. I have forwarded my observations and your suggestion to her treating psychiatrist. I hope he takes them under advisement and contacts me soon. Her certainty we have considerable wealth is mistaken. I am very concerned for her wellbeing and our financial future. If it is determined she truly wants a divorce, I will give it to her, however, I see no other option in order to protect me from her impulsive spending that did not exist before. I am very nervous. Thank for your help.

Answered by Dr. Shubham Mehta (11 minutes later)

Brief Answer:
appropriate drug treatment can improve her condition.

Detailed Answer:
You are most welcome.

The behavioral signs which you have described here are mostly suggestive of psychosis.
This probably can be a manic switch (bipolar disorder) due to her current drugs or may be an independent psychotic disorder.

Most certainly, she need a drug-change.
However, I would also like to tell you that her condition is manageable with drugs if the right drug is given to her.
Before considering a divorce, consult your local psychiatrist for opinion.

I hope she gets the appropriate treatment.

Hope you find my suggestions helpful.

Kindly close the discussion if you have no more queries and give your valuable feedback.
You can also contact me directly by visiting my profile, if you have more queries in future.
I will be happy to help.

Take care.
Thanks.

Dr. Shubham Mehta, MD (Psychiatry).

Note: For further guidance on mental health, Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar