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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by Dr. Bob on September 19, 2003, at 18:34:36
In reply to frustration with difficult-to-treat psychosis, posted by Dr. Pete on September 18, 2003, at 21:35:36
> I am Dr. Pete. I help people for a living. I am a caring and competent Internist. Part of what makes me so caring is my wife. Because I live with her suffering everyday, I can relate to my patients' pain and suffering. My wife has a problem. Different psychiatrists call it different names: bipolar disorder with psychosis, schizophrenia, or schizoaffective disorder. We have been on a rollercoaster ride with many different medications.
> Lately, she was max'ed out on lithium, risperdal and zyprexa (600 Bid, 8 Qd, 40 Qd respectively) and not improving. Our psyche decided to drop the "Vitamin R" and try Abilify.
> Everyday is filled with anxiety, fear and frustration--for me too. If only we could find that magic combination. I have noticed that Provera on one occasion snapped her out of her illness within 48 hours. I am reluctant to try it again but if we get desperate enough...
>
>
Posted by Lazarus on September 19, 2003, at 20:06:47
In reply to frustration with difficult psychosis « Dr. Pete, posted by Dr. Bob on September 19, 2003, at 18:34:36
Do not worry. I am have Bipolar II, Rapid Cycling and have found the combination of lithium and zyprexa to be a good one. Yet, at times I still don't feel right. Thus, I have been dabbling with Abilify, and find that it is excellent at making one feel comfortable with oneself. I take 5 mg (one-half of a 10 mg tablet) every other day. My psychiatrist says that a single dose of Abilify stays in the body for three days.
I hope this information helps your wife.
Lazarus
Posted by galkeepinon on September 19, 2003, at 21:21:33
In reply to frustration with difficult psychosis « Dr. Pete, posted by Dr. Bob on September 19, 2003, at 18:34:36
I am so sorry you are going through this. You sound like a very supportive husband~kudos!
She was taking 1200mg Lithium, 8mg of Risperdal, and 40mg of Zyprexa everyday???? That IS pretty maxed out:(
It's odd that you mention Provera. I have read that Provera actually can intensify depression. I take it once in a while to start menses, and feel a little *down* when I do, I can tell a difference.
Personally, I am not familar with schizophrenia or schizo-affective disorders. I have a friend who is on Abilify and it works great for her. She was diagnosed with schizo-affective.
You say you're an internist. Do you feel that having her on Provera isn't a good thing? Because you say 'I am reluctant to try it again'
Why? Is she on HRT now?
I pray that you find that 'magic combination'~it can happen and it does happen, and I hope it happens for you both:-)
Hope this helped a little and all the best to you and your wife!
God Bless.> > I am Dr. Pete. I help people for a living. I am a caring and competent Internist. Part of what makes me so caring is my wife. Because I live with her suffering everyday, I can relate to my patients' pain and suffering. My wife has a problem. Different psychiatrists call it different names: bipolar disorder with psychosis, schizophrenia, or schizoaffective disorder. We have been on a rollercoaster ride with many different medications.
> > Lately, she was max'ed out on lithium, risperdal and zyprexa (600 Bid, 8 Qd, 40 Qd respectively) and not improving. Our psyche decided to drop the "Vitamin R" and try Abilify.
> > Everyday is filled with anxiety, fear and frustration--for me too. If only we could find that magic combination. I have noticed that Provera on one occasion snapped her out of her illness within 48 hours. I am reluctant to try it again but if we get desperate enough...
> >
> >
>
Posted by BarbaraCat on September 20, 2003, at 21:24:26
In reply to frustration with difficult psychosis « Dr. Pete, posted by Dr. Bob on September 19, 2003, at 18:34:36
Hi Dr. Pete,
Thanks for being here and sorry you're having such a painful time. It's really my husband who should be giving you the pat on the back because he's been so supportive of my BP-1 mixed states episodes. The guy must REALLY love me! I've been on lithium 600mg and lamictal 125mg for a while and it's helped. Before the lithium and Lam, my mixed states were horrendous, horrible and psychotic. I've since improved greatly, but have gotten terribly depressed even though on medication. I also have fibromyalgia and something just seemed off, not being addressed by my meds.I've received very little quality care from my HMO docs and pdoc. They're adequate and they care, but I've been frustrated with the 15 minute appointments that simply aren't enough to unravel my bio-mystery. I'm given pills for my symptoms and sent on my way. I have to insist on getting lab work beyond the routine formulary kind. I'm hypothyroid and constantly have to monitor my own levels and ask for med adjustments to keep my TSH levels below 3.0. My PCP doc seems to think that borderline hypothyroid is acceptable and asymptomtic - wrong! The thyroid, as you well know, is a crucial element in any mood disorder, and as you are well aware, all hormones will interact in bizarre ways if any one of them is off balance.
Being menopausal, I've been on HRT in the form of the Estraderm patch and Prometrium, cookie-cutter, one size fits all dose. I came down with endometrial hyperplasia and a biopsy suggested 'estrogen excess' - my estrogen was not being opposed by progesterone because there weren't any! The month I was on a super dose of megace I felt absolutely great! My lining shed, I went back on my cookie cutter dosage and felt crappy within a few months again.
So, I went to a naturopath and did some extensive lab work, mainly saliva and blood spot testing for hormones and human growth hormone. My tests came back with my ratio of progesterone to estrogen at near zero, even though I was taking the oral Prometrium. Basically, I wasn't absorbing it orally.
Other levels of hormones were dangerously low, i.e., testosterone and DHEA, and my HGH levels were near zero. She was not at all surprised, given these numbers, that I had severe fibromyalgia. My thyroid TSH is also all over the scales because of lithium's goitrogenic properties. I know there's controversy about saliva tests vs. serum for accuracy, but these saliva tests are pretty darn sensitive and, according to my successful protocol based on the lab values, very accurate. She uses ZRT Labs in Portland, OR.
Since then I've been using a compounded bioidentical hormone topical cream and the difference is amazing. I'm not 'cured' by any means, but I'm much improved. It will take time to correct the imbalances, but I can very emphatically state that much of my difficulties have been due to a hormonal imbalance - and NOT picked up by any blood work through my regular doctors.
Your wife may not be menopausal and may not be obviously hormonally challenged, but as you well know, an low level of progesterone can cause terrible anxiety. The fact of her improving on Provera should raise a very large red flag that something is off hormonally.
The hormonal influence is so crucial and so little considered or researched in mood disorders. I've NEVER been instructed to get lab work for all major hormone levels by any pdoc I've ever seen. Men don't get bloating, premenstrual migraines, PMS psychosis and don't make the connection how miserable hormones can make us feel. Our mood disorders do not only evolve from the the area above our ears. I hope if you decide to explore this, please consider not using synthetic hormones. The synthetics cause big bad problems, don't let anyone tell you differently. Do some research and consider the bioidentical ones, preferably topically. Dysbiosis, compromised absorption and liver function is a big factor for anyone on many meds and topical seems to be the most efficient delivery system. Much good luck to you and your wife. - BarbaraCat
>I am Dr. Pete. I help people for a living. I am a caring and competent Internist. Part of what makes me so caring is my wife. Because I live with her suffering everyday, I can relate to my patients' pain and suffering. My wife has a problem. Different psychiatrists call it different names: bipolar disorder with psychosis, schizophrenia, or schizoaffective disorder. We have been on a rollercoaster ride with many different medications.
> > Lately, she was max'ed out on lithium, risperdal and zyprexa (600 Bid, 8 Qd, 40 Qd respectively) and not improving. Our psyche decided to drop the "Vitamin R" and try Abilify.
> > Everyday is filled with anxiety, fear and frustration--for me too. If only we could find that magic combination. I have noticed that Provera on one occasion snapped her out of her illness within 48 hours. I am reluctant to try it again but if we get desperate enough...
> >
> >
>
Posted by Pfinstegg on September 21, 2003, at 10:37:40
In reply to Re: frustration with difficult psychosis « Dr. Pete » Dr. Bob, posted by BarbaraCat on September 20, 2003, at 21:24:26
Your wife is so fortunate to have such a supportive husband, and I do wish you both success in finding the best possible treatment combination.
I am a physician, too; I have PTSD with anxiety and depression from childhood abuse. I strongly support BarbaraCat's suggestion to see if hormones are playing a role in your wife's illness. To relate my own experience: I have been slightly hypothyroid for about the same number of years that I have been really struggling with depression. Although I took synthroid during that time, and had a normal TSH of 2-3, I really noted an improvement in my depression when my endocrinologist added Cytomel and aimed for a TSH of 0.5 or under. (I do have frequent bone scans (normal so far) and take a lot of calcium).
Like many post-menopausal women, I was taking HRT until last year. When I stopped taking it, my depression once again worsened severely. So my gynecologist and I have been trying to work out what the least dose of HRT can be. At the moment, it is Ogen (a plant-based estrogen) 0.5 mg and Provera -2.5 mg. twice weekly,
Just to round things out, I should include that I have received one course of TMS, which was extremely helpful, and now have booster sessions approximately every four months. I also take Lexapro 10 mg. and am engaged in psychoanalytically-oriented psychotherapy. With all of this, I am feeling much, much better. Many of the things I tried- the Cytomel, aiming for a TSH of under 0.5, trying to deal effectively and safely with the fact that some women have estrogen-sensitive depression, and the TMS- were all things that I learned here or on Medline.
I wish you both the very best in dealing with this incredibly challenging illness, and hope you will continue to keep us informed about how things are going.
Pfinstegg
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