Thank you for your question, I’m Dr. Vikas (M.D Psychiatry) and I’ll try to help you.
Any type of stressor or stressful situation can worsen or aggravate the Bipolar disorder symptoms.
Stressful married life can be an precipitating or aggravating factor for Bipolar illness.
no problem, I got it.
Well, out of all the medicines, she is currently taking, Diazepam, Clorazepatum (?) are probably benzodiazepines, Pregabaline is an antiepeleptic which is used as an additional drug for bipolar disorder.
I am not sure about use of potassium, it is not the standard medicine for Bipolar disorder.
I am not able to see any regularly used mood stabilizer
is she taking only these medicines?
well, it depends on the clinical diagnosis and symptoms.
there are no mood stabilizer in all these medicines except Pregabalin which is also not a routinely used mood stabilizer.
ok, but what is the reason behind taking 2 benzodiazepines and a antiepileptic medicine.
do you know something about her symptoms for which she was prescribed these medicines.
no problem, please take your time.
and for these symptoms she was prescribed these medicines?
you have mentioned?
OK, and is she responding to these medicines?
OK, thanks for your reply. So to summarize, she is a known case of depression who was admitted in hospital because of allergic reaction to Primperan.
After discharge, she started experiencing new symptoms such as restlessnes, frequent and excessive talk, hyperactivity, irritability, dypshoric mood.
See, these symptoms are somewhat suggestion of manic phase of Bipolar illness and don't resemble depressive symptoms. Assuming that now she is suffering from Bipolar illness, antidepressant can make them worse.
and may be that is why her doctor stopped antidepressant.
Symptoms she is experiencing currently should respond to a mood stabilizer like Abilify (Aripiprazole), Seroquel (Quetiapine), or Dicorate to name a few.
Pregabaline is not the appropriate choice in my view for controlling her current symptoms.
I agree with you in this. Her medicines can be reviewed by a psychiatrist if possible.
there is no need to take 2 benzodiazepines like Diazepam and Clorazepate at the same time.
Pregabalin is an antiepileptic and is used by some doctor as an additional medicine for mood disorder
but probably will not be able to control her symptoms fully also in my view.
in that case, wait and watch should be the best police.
at least, these medicines will not worsen her symptoms in my view.
in my view, adding a mood stabilizer may be helpful.
her doctor can also consider the option of removing one benzodiazepine if possible.
see, Dicorate used in Bipolar disorder is also an antiepileptic medicine.
but it is also the first line medicine for treating Bipolar disorder and epilepsy
Pregabaline can be used as and additional medicine in Bipolar disorder.
that sounds a reasonable prescription to me :)
You are most welcome. Right now, I don't think, she require an antidepressant.
medicines such as Seroquel or Abilify can help in both
manic and depressive symptoms
so her doctor can also consider the option of adding either Seroqeul or Abilify while continuing the other medicines.
one of the two benzodiazepines she is taking currently can be stopped although.
see, all three of these medicines are more or less equal in my view and it varies from patients to patients.
Dicorate has totally different mechanism of action in comparison to Abilify and Seroquel which are atypical antipsychotics and mood stabilizers.
it will depend on the personal choice of her doctor which medicine he or she prefers the most.
You are most welcome.
Thanks for coming to JA.