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Dr. Vikas
Dr. Vikas, Psychiatrist
Category: Mental Health
Satisfied Customers: 2209
Experience:  MBBS ; M.D Psychiatry, MS. Health Informatics
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My daughter is 17 1/2. She says that she started experiencing

Customer Question

My daughter is 17 1/2. She says that she started experiencing depression at 12 but never told anyone. At 12 1/2 she had a near fatal case of viral encephalitis, but seemingly full recovered. At 15 she requested we put her on anti-depressants. We tried Lexapro first, and at first it seemed to help. At 45 days she experienced extremely suicidal thoughts which landed her in a teen/child mental health unit. They took her off Lexapro and instead tried Lamictal. She had a severe skin reaction within a couple days. Then we tried abilify, which helped somewhat, but 5 months later it seem to wane, so her pdoc added Cymbalta. This put her in crisis mode in about 5 days. We admitted her and then tried upping the cymbalta dose. Big mistake. About a month after ending the Cymbalta we started her on Lithium. It also helped for the first couple months then waned. We upped the dose. She is now on 1200mg/day but is now saying she is back to suicidal thinking on a regular basis. However at least on the lithium we are not seeing the lethargy/personality loss we saw on the Cymbalta or Abilify. Anyway, at my wits end. Whats the logical next step? Also, she has been in CBT one-on-ones and groups since this started when she was 15.

Any ideas appreciated.
Submitted: 3 years ago.
Category: Mental Health
Expert:  Dr. Vikas replied 3 years ago.
Hello Madam,

Could you please mention all of her symptoms she is currently having other than suicidal ideation.

Is she also complaining of sadness or any have other symptom pointing towards depression?

Kindly also mention the other medicines if she is taking any besides Lithium?

Thanks

Vikas
Customer: replied 3 years ago.

She is not taking anything other than Lithium on a daily basis. We do have Xanax that we use if she gets real bad (only once a week if that).

 

Here are comments she makes routinely:

1) I have no friends and nobody loves me.

2) I'm not a good person

3) I'm hopeless

4) I'm fat, ugly, etc.

 

She is a nice looking 17 year old girl who graduated from high school a year early and has almost 2 years of college under her belt. She does not want to go to school in the fall and is withdrawing on a dailty basis.

 

Expert:  Dr. Vikas replied 3 years ago.
Thanks for your reply. I will get back to your shortly with my answer.
Expert:  Dr. Vikas replied 3 years ago.
Antidepressants when given to a patient may induce hypomania, mania / bipolar disorder which is sometimes associated with suicidal ideation. In this case, the usual strategy is to add a mood stabilizer such as Lithium, Lamotrigine, any other atypical antipsychotic such as Abilify and / or discontinuation of the antidepressant in question.

Probably this happened to your daughter also. Every time your daughter was prescribed an antidepressant, her condition worsened and which improved by stopping that antidepressant and adding Lithium or abilify.

It appears to me that her current symptoms are very much suggestive of severe depression. Lithium is a mood stabilizer but it can't control the depressive symptoms and therefore a logical step should be to add a medicine / treatment modality which is able to control her depressive symptoms with suicidal tendency.

Usually, in patient suffering from depression with suicidal tendency Electro convulsive therapy (ECT) is a very good option and is very effective. Patients respond immediately to ECT in comparison to medicines.
Electroconvulsive therapy (ECT) If you don't want to consider the option of ECT, the other alternative could be to add Lamotrigine/ antidepressant along with Lithium.

Since she developed serious skin rash with Lamotrigine it can be left out so a combination of Antidepressant along with Lithium could be a good option.

It depends on her psychiatrist, which antidepressant he /she would like to add with Lithium but we usually prefer Wellbutrin (Bupropion) or Pristiq for this purpose.

You can discuss with her doctor about the options I have mentioned and hopefully she will get better very soon.

If you have any other query, please feel free to ask.

Wishing her a very early recovery and best of health in near future.

Regards

Vikas


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