Uncooperative doctor - changing meds

Hi there, my father is bipolar and is taking Olanzepine 20mg and Depakote (unsure of that dose) and has been doing so for around 2 years now. He sleeps 18 hours a day (I'm not exaggerating) and he says he is depressed, despondent and shows little interest in anything. We had a meeting with the doctor to talk about his medication in the hope of changing it but she didn't seem to want to change it at all, after a lot of pleading and talking she agreed to add in a low dose of an antidepressant. Now, the thing is, I am aware that antidepressants are bad news for bipolar patients and she even said that he will need to be monitored closely on this in case his mood becomes too high and he starts going manic. I brought in some suggestions for alternatives for the Olanzepine, one of which was Lamictal, which is an alternate mood stabiliser that specifically is known for helping with the depression. She didn't seem interested in prescribing this medication, should I talk to gp? What to do?

Has anyone here taken Olanzepine and Depakote? What were your side effects?

Has anyone taken Lamictal? What were you side effects?

Should he be taking TWO mood stabilisers like this?

What are you opinions on adding in another medication, i.e the antidepressant, rather than switching one of the mood stabilisers?

Thank you!

Hi, yes, you are right to ask about addiction. The whole reason that we have gotten involved and asked for a medication change and extra help is that up until around a month ago he was drink quite heavily ever day. I was not aware that he was drinking so much until I saw him falling over paralytic drunk one day, unable to speak properly etc. I thought he was having a heart attack or something, so we went to the hospital and worked out that he was just drunk.

ANyway. He hasn't touched a drop since then, we have made sure of it. He is better since then, I mean the alcohol will screw anyone up. But I do wonder about the medication, because he says that it was not helping and didn't help with the depression, which is why he drank.

What is your opinion on him being on the highest dose of Olanzepine?

Is Depakote a good idea?

Do you think it's wise to prescribe an antidepressant in this case?


What was your experiences of using Lamictal? Apparently this is an alternative to Olanzepine (i.e does a similar thing) yet has antidepressant properties. It seems to me that swapping the Olanzepine (which is known to cause tiredness) for this would be a good idea rather than the potentially risky antidepressant.

What do you think?

I mean, I'm not a doctor, but I can read and research like anyone else and it seems like the doctor has not prescribed the best option. I very much think that the Lamictal might help him a lot more.

Problem with this though is that doctors have very large egos and dont want anyone else questioning what they say. I also don't want to get in the way of any useful treatment if it does turn out that what he is on is the best road.

What are the side effects of Lamictal?

What are your opinions of the side effects of Depakote and Olanzepine? Does the liver toxicity worry you at all? I mean three medications is not healthy for anyone!

Should we ask for his medications to be reduced over time?

I feel like this might be another option that might be more workable with the ego of the doctor, if they wont change the medication, then perhaps they'll reduce it.

I mean, the whole idea of these meds is to just stop the episodes right? SO as long as no episodes happen then it's doing its job and anything more than what is needed for that is overmedication?

Thanks..


Oh, just on another note, what kind of experience of behavioural therapy, counselling etc has anyone had with help in these things?

I think he also puts an unrealistic emphasis on the drugs to sort his life out and he doesnt take much responsibility for taking any action to better himself. He never goes out, shows no interest in people etc.

We call the Epilum and Zyprexa, respectively, so please excuse me calling them by the names I know them by because I have trouble with delirium and mind is not as versatile as a well one.

Both Epilum and Zyprexa treat mania, so the fact he is sleep 18 hours a day would make me suspicious that he is might only need one mood stabiliser/antipsychotic or his doses reduced on one or both of these powerful medications.

As far as I know, these drugs tend to treat mania better than depression and he either needs a lighter dose, or if his mania is pronounced on a lighter dose, he keeps the dose the same but treats his depressive symptoms with an antidepressants. I have found efexor and valdoxin both very good - but they have been really bad for others, especially efexor. Personally, I can't withstand Epilum or Zyprexa, so your father has a very different metabolism to me anyway.

Your father's doctor seems to be a GP rather than a psychiatrist. Most psychiatrists seeing such pronounced depressive symptoms would not fear mania in your father in the way this doctor does. Antidepressants are certainly not bad for bipolar patients as a general rule. It depends on the patient, the features of their specific illness and what other medications they are taking. Your father's doctor seems very clunky when it comes to what can and can't be done with anti depressant medication for bipolars, especially given the extreme neuro-vegetative effects your father is experiencing (assumedly from the anti-mania medication). Purists forget that bipolar doesn't read their textbooks and many practitioners find they have to treat depression with antidepressants, mania with mood stabiliser or anti-psychotics. Anti psychotics can also help if there is psychosis, but anti-psychotics are still used for mood stabilisation in bipolar patients who do experience psychosis).

Wow, I just read this is a psychiatrist!!! I'd change psychiatrists! (Assuming there is the possibility for more appropriate care in whatever healthcare system you are in, whereever you are in the world).

I got severe anxiety with both Epilim and Zyprexa. I didn't get past the first minuscule dose of either of them. Lamictal I took for a year or so. It was good until developed severe dystonia and myalgia/arthalgia at 25mg.

Unless your father has psychosis and the Zyprexa is treating that, I cannot understand from what you have said why there would be need for two of these medications. Even people with psychosis with their bipolar can get away with an antipsychotic to treat mood disorder and psychosis simultaneously. There could be a good reason but no clues for it are given in your post.

If your dad suffers from psychosis, I would keep the zyprexa and add a low dose of antidepressants just at the times of excessive depressive symptoms and taper back when approaching normal mood and cease at normal mood. (In my case, I've been bipolar my entire life and anti-depressants the foundation of my treatment. I also have ptsd and require it for that as well as the fact my bipolar has far more depression than hypomania or mania. I've only just had my first manic attack at 42 but I only had to reduce one of my anti-depressant to come out of it). I find Efexor is a good antidepressant because it treats both depression and anxiety (but your father mightn't have anxiety). I do know other bipolar sufferers who also just use Efexor alone. So what your father's pdoc says about antidepressants is hog wash (Yes, bipolars can and do go high on antidepressants but not on a low dose at times they have severe major depression!).

Alcohol is a depressant and if your father is self medicating with a depressant because the medication wasn't working, that would ring alarm bells for most pdocs. It is difficult over the net because one can never write down everything and sometimes some important points can inadvertently be missed because we don't know it is a vital piece of the puzzle, so I will refrain from doctor bashing :)

Please do encourage your dad to stay off the alcohol. Alcohol is one of the worse drugs for bipolar. What goes up must come down and alcohol triggers dangerous lows for bipolar sufferers.

20mg of Olanzapine seems excessive, especially being on the zyprexa as well. No wonder the poor old boy sleeps 18 hours a day! Again, sleeping 18 hours a day would ring alarm bells for most pdocs. Anti-depressants aren't risky per se. They are risky for some and your father has enough "downers" on board to sink a small ship.

I think your dad is very lucky to have you. You do seem far more on the right track than the doctor with a big ego.

Any good doctor gets liver function tests done when required so that if there is any impact on the liver it is picked up straight away and damage is averted. You are right it is best to avoid polypharmacy where possible. Sometimes it isn't but it seems as though it may be in your dads case. Again remember, alcohol can be just as damaging on the liver than prescribed drugs and it is to be counted as yet another drug in the mix if it consumed. Psychotropics are indeed powerful drugs that need to be treated with respect. It is best to keep the number of drugs to a minimum and the doses to a minimum but at the same time not get to scared if a combo of drugs at a higher dose is required to treat a very serious illness adequately. (Not that your dad's doctor seems too worried about multiple drugs at high doses).

This isn't and should never be about trying to manage a doctors ego. This is about managing your dad's illness as best as possible. And if that means stepping on the toes of a doctor with a God complex, so be it. Nevertheless, I am concerned (from what you have said) that this doctor may not be treating your father effectively. I'm not saying that is the case, but I don't think a second opinion would be a bad idea at all!!! I think psychiatrists especially need to be more down to earth if they are to be effective. You can't get someone's trust if you are talking down at them from your ivory tower. That rapport is essential in psychiatry because it is such a personal, emotional and intimate speciality.

Yes, anything more than what is effective is overmedication but also do be careful that you don't err on the side of undermedication, which is also quite common. There needs to be a balanced approach on the part of the doctor for effective prescribing, imho.

Dialectical behavioural therapy (DBT) is a very good therapy for bipolar and there is even a dbt workbook for bipolar. EMT is another good therapy. Acceptance and Commitment therapy (ACT), I don't think is as effective for mental illness as it tends to miss a few safety issues. I think ACT is better for the psychological issues alone, without any underlining psychiatric disorders, where DBT and EMT are actually geared towards the psychological treatment of psychiatric disorders.

Because your father is managing to avoid substances as he is, that is a positive sign for now at least, that their may not be an underlying addiction but that he is doing just what he said he was doing - self-medicating because his meds are not doing what they are meant to do. Often finally getting meds right, can take away the desire for alcohol in the self-medicating patient in itself. Hopefully, he is "just" bipolar, fingers crossed hey! It would be worth giving your dad the information on how alcohol affects his treatment for the worst, so at the times he has the desire to have a drink, he has the knowledge that it is a short term gain and a good therapy will also help him with urge-surfing.

He's lucky to have you for a daughter (I'm assuming)... apologies if you are a son :). Let us know how you get on. :)