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I was diagnosed with Bi-polar typeII at age 26 am now 36. Was initially prescribed Depakote and neurontin (and high doses of vitamins.) I am now taking 100mg of Lamictal 2 a day, 300mg of neurontin 4 a day, 60 of paxil recently upped from 40 and Trazadone as needed for sleep. These medications seem to work except the Trazadone is way too intense. I had a, well, a bad day (month) a couple of years ago at age 34 where I did cut myself in vague suicide attempt; I couldn't take it anymore and it seemed good idea for roughly 15-20 sec. This was and is only time I have ever commited violence to myself or another. After commital, an illegal one but certainly neccessary, that lasted a week I asked for Lorazipam...stat! The (Dr.) that saw me on release who was only able to see me over internet connection. Due to my rural location and no insurance I have little choices in treatment. In fact he is the only MD I have seen in the last 10 yrs. at current clinic. I was told, "I would rather see you in therapy." I have cripiling social anxiety and do not want people in my town of 3000 ppl. to know anything about my 'disorder'. Long story short the NP that had been seeing me for almost 5 years prescribed Ativan to the dismay of the internet guy. I took .5mg of Ativan for 12-14 months. These were the best months of my life so far since my initial diagnosis. Well after this time and having seen the internet doc every 3 months for 5-10 min each visit the prescription was not renewed. Without warning. By the way the NP was mysteriously not working there for my next visit a month after she had prescribed the Ativan. Since then I have struggled. Im barely able to enter a grocery store. I worry uncontrolabley about nonsense; world events, any appointments, conversations from the past, embarrasing moments from when i was 5 to 5 days ago...I hate feeling like this and don't know what to do. The NP that is seeing me now tried to put me on Propranolol to help me sleep! ???
Welcome to the site.
I am Dr. Kaushik and I believe I can help you with your problem.
I have read all the details in your question but can you please tell me what is that you want to ask ?
I guess it's more of a situational analysis question. If you were in my shoes what would you do? I know what medication works but am stigmatised for requesting it even though I have never had dependency issues involving illegal or legal medications yet fell labeled as such. Doesn't Bi-polar disorder deserve even occasional meetings with actual MD's?
Well I believe you did the right thing to ask for a psychiatrist because he is an expert who knows the intricacies of Bipolar management and will be more equipped with knowledge to provide you the best treatment possible for your condition.
Also I will like to tell you that if Ativan use at 0.5 ,mg / day was giving you relief with your anxiety then it can be taken on PRN basis that is as and when needed at times of overwhelming anxiety/ stress.
Now coming to your drug regime I reckon that it is a decent one except that you are overloaded with anti depressants such trazodone and paxil , both of which when used in combination need to be taken at a slightly lower doses. Also I must mention here that 60 mg dose of paxil is more than the maximum safe dose of this drug which is 40 mg / day. Also excessive use of anti depressants like this may lead to unmasking of hypomania that will precipitate the bipolar 2 symptoms. So I will suggest you to ask your psychiatrist to cut down on the doses of both trazodone and paxil where paxil needs to be brought back to 40 mg / day and trazodone to be used at 25 or 50 mg / day dose only.
I hope this helps to answer your query.
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