Sign-in to Ask A Doctor - 24x7
OR
Sign in with GoogleGet your health question answered instantly from our pool of 18000+ doctors from over 80 specialties
Suggest Treatment For Bipolar Disorder
My 24 year old son was diagnosed with bipolar 3 months ago. Up until the age of 18 he was hardworking, personable, athletic and good at school (he even had a football scholarship to a Division I college but only stayed there 3 days and left). It’s been a rollercoaster since then. We got him to a psychologist about 5 months ago and he was the first to suggest he might be bipolar after several sessions and hearing about his history for the last 7 years. He has been in and out of school and jobs never quite finishing any of them. He has addiction problems with marijuana, alcohol and zanax. He has been in several car accidents and been arrested 4 times for drug possession (small amounts). He didn’t go to prison but was court ordered to rehab for 6 months when he was 19 and put on probation. He starts using again soon after his probation ends (there are mandatory drug screenings when on probation). Since then, he has started school or started a job but he always ends up quitting (anxiety is the reason he gives). He recently came back to live with us (his parents) and we took him the psychologist who thought he might be bipolar and sent us to a psychiatrist for evaluation. We brought him to a large practice and the first appointment he could get was with the Advanced Registered Nurse Practitioner, with the meds prescribed under the psychiatrist. He is on the following medicines right now:
ROPINIROLE HCL 0.5 MG I tablet at bedtime (restless leg syndrome)
SERTRALINE HCL 100 MG 1.5 tablets each morning
LAMOTRIGINE 100 MG 1 tablet at bedtime
BUSPIRONE HCL 5 MG 1 tablet in morning and 1 tablet at bedtime
I monitor his medicines so I know he is taking them but It's difficult to know if the meds are working because of the drinking, pot, etc. He recently had another car accident and pot was found in his car so he was arrested but bailed out on a misdemeanor. He was at his lowest point after that and I was worried about suicide (he wouldn't attend Christmas family events) so we convinced him to go to a dual diagnosis rehab facility a few hours from our home. He has been there less than a week but is already calling me to say it’s not the right place for him; says it's just drug addicts and not mental health related. He had a seizure the first night there and spent the first 3 days in the hospital for detox and the neurologist said the seizure was from zanax which he took in large amounts but had stopped taking about 5 days before going to rehab.
I am striving to do the right thing to help my son and not sure if this latest attempt is right or another type of therapy or rehab would be better. I chose this one since it said dual diagnosis since he needs to get clean from his addictions but also get his bipolar accurately diagnosed and treated appropriately.
I would greatly appreciate your insight.
ROPINIROLE HCL 0.5 MG I tablet at bedtime (restless leg syndrome)
SERTRALINE HCL 100 MG 1.5 tablets each morning
LAMOTRIGINE 100 MG 1 tablet at bedtime
BUSPIRONE HCL 5 MG 1 tablet in morning and 1 tablet at bedtime
I monitor his medicines so I know he is taking them but It's difficult to know if the meds are working because of the drinking, pot, etc. He recently had another car accident and pot was found in his car so he was arrested but bailed out on a misdemeanor. He was at his lowest point after that and I was worried about suicide (he wouldn't attend Christmas family events) so we convinced him to go to a dual diagnosis rehab facility a few hours from our home. He has been there less than a week but is already calling me to say it’s not the right place for him; says it's just drug addicts and not mental health related. He had a seizure the first night there and spent the first 3 days in the hospital for detox and the neurologist said the seizure was from zanax which he took in large amounts but had stopped taking about 5 days before going to rehab.
I am striving to do the right thing to help my son and not sure if this latest attempt is right or another type of therapy or rehab would be better. I chose this one since it said dual diagnosis since he needs to get clean from his addictions but also get his bipolar accurately diagnosed and treated appropriately.
I would greatly appreciate your insight.
Fri, 7 Nov 2014
Hello Welcome to HCM
I have read the history and I can understand your concern. Your son of 24 years age was apparently normal till the age of 18 when he moved to a football scholarship camp and within three days he developed symptoms and he left the camp. His condition progressively deteriorated since then and he started abusing marijuana, alcohol, alprazolam. He was involved in many legal problems and he was also sent to rehab. He has been provisionally diagnosed with bipolar disorder. He is currently on Sertraline 300, Lamotrigine 100, Buspirone 10, Ropinirol .5 per day.
Now coming to discussion-
Most probably he developed seizures because to alprazolam and alcohol withdrawal. Withdrawal or sudden cessation of use of these drugs result in seizures. So as per my opinion first thing that need attention is to detoxify him. The initial phase takes about 5-7 days in which gradually tapping doses of long acting benzodiazepines are given. Once patient gets better in maintenance phase anticraving drugs are given. After detoxification you should consult his psychiatrist again for reevaluation. As per my opinion he is not getting enough doses of mood stabilisers. He is on Sertraline and Buspirone which will cover depressive and anxiety symptoms. Lamotrigine is a mood stabiliser but there are other options available. Drugs like Sodium Valproate etc can be used in such complaints to decrease his aggressive behaviour and to treat bipolar disorder.
Consult a Psychiatrist for better opinion.
Hope this helps you, thanks
I have read the history and I can understand your concern. Your son of 24 years age was apparently normal till the age of 18 when he moved to a football scholarship camp and within three days he developed symptoms and he left the camp. His condition progressively deteriorated since then and he started abusing marijuana, alcohol, alprazolam. He was involved in many legal problems and he was also sent to rehab. He has been provisionally diagnosed with bipolar disorder. He is currently on Sertraline 300, Lamotrigine 100, Buspirone 10, Ropinirol .5 per day.
Now coming to discussion-
Most probably he developed seizures because to alprazolam and alcohol withdrawal. Withdrawal or sudden cessation of use of these drugs result in seizures. So as per my opinion first thing that need attention is to detoxify him. The initial phase takes about 5-7 days in which gradually tapping doses of long acting benzodiazepines are given. Once patient gets better in maintenance phase anticraving drugs are given. After detoxification you should consult his psychiatrist again for reevaluation. As per my opinion he is not getting enough doses of mood stabilisers. He is on Sertraline and Buspirone which will cover depressive and anxiety symptoms. Lamotrigine is a mood stabiliser but there are other options available. Drugs like Sodium Valproate etc can be used in such complaints to decrease his aggressive behaviour and to treat bipolar disorder.
Consult a Psychiatrist for better opinion.
Hope this helps you, thanks
I find this answer helpful
Disclaimer: These answers are for your information only and not intended to replace your relationship with your treating physician.
This is a short, free answer.
For a more detailed, immediate answer, try our premium service
[Sample answer]
Related questions you may be interested in
Recent questions on Lamitor
Loading Online Doctors....