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Ask Dr. Ed Wilfong Your Own Question
Dr. Ed Wilfong
Dr. Ed Wilfong, Psychologist
Category: Mental Health
Satisfied Customers: 1528
Experience:  Twenty-five years treating all ages; Specialities: psychopharmacology & diagnosis, MMPI-2, testing.
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My son is taking 1500 mg depakote and 100mg seroquel to

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My son is taking 1500 mg depakote and 100mg seroquel to treat bipolar mania. However, he has gained 40 lbs. and has hair loss, and he sometimes has "flat effect". Is there anything better out there? I've been thinking of taking him to Amen clinics to have his brain scanned. Why is it that psychiatry is the only branch of medicine that does not look at the organ affected and only treats the sypmtoms?
There are different medications available. Despite weight gain and hair loss (which is very rare-these are likely due to depakote. The seroquel is like not causing much of these effects. It certainly difficult, but you son is on a good combination of medications. It appears he is being treated for manic episodes that may have been quite extreme. I can't say there is a better treatment, only different, and may not work as well. The flat affect is a consequence of his emotional range being constricted in order to avoid the harmful extremes.
I would be interested in what scans you would expect to help. The problem you son has is one that the balance of neurotransmitter in his brain is off. The only way to measure it is th actually cut into a section of his brain. Blood levels taken only tell if the amount in the bloodstream is safe and in the range that typically results in changes in the biochemistry of the brain. A CT and/or an MRI would not show anything other structural brain abnormalities, not chemical. PET scans are in experimental stage for brain chemistry. The measure the sugar metabolism in different areas of the brain. Sugar metabolism show how much energy each section of the brain is using. We know that some psychiatric conditions have different areas of lower or higher sugar metabolism. Now how that translates into practice is anyones theoretical guess. Then the question is do you scan him medicated or not? Someone will gladly take your money for a scan and show you some really interesting pictures. I don't know that it would change his treatment.

You over estimate medicine in general. The vast majority of the time a doctors treatment is based only on symptoms. Even things like lab values are measuring symptoms. The equivalent in mental health is Psychologists, who do measure how different aspects of the brain are functioning through psychological testing. Treating only the symptoms implies not treating the disease. To my recollection, the last disease medicine "cured" was polio. Just some disease are more transient than others. Bipolar tends not to be subject to fixing the cause of chemical imbalance, but rather supporting correcting the imbalance on ongoing basis. The side effects are the result of not being able to develop chemicals that affect only the specific chemistry affected.

Hope that gives you some explanation.
Customer: replied 7 years ago.
What are the other meds that could possibly help? Isn't there one to treat this disorder without weight gain? How often does the blood need to be checked for glucose?Does one's overall health need to be jeopardized in treating bipolar? Will these meds eventually need to be increased because the body has built up a tolerance level?
Lithium used to be the norm, but no better than depakote for side effects. To types of meds are generally used. Anticonvulsents (depakote) and antipsychotics (seroquel). Seroquel is best for not having weight gain, but may not be effective on its own. He should probably be checked every 6 months for blood glucose H1AC, but it depends on his BMI (Body Mass Index). Unfortunately, this is a disorder with no easy solution and there are trade offs. I also understand this weight take twice as much effort to manage and lose. Exercise and nutritional plan are best. Doctor should be able to help you with both. This is truly a disorder than one must weigh than long term health risks against the possible of serious and acute danger if not treated. These medications may need slight adjustment from time to time due to symptoms and changes in metabolism, but tolerence does not develop with either of these drugs.
Customer: replied 7 years ago.
I understand that anxiety disorders can have similar symptoms, and that a doctor will treat the most obvious ones. In my son's case, mania, therefore the medication of depakote and seroquel. However, are there any more natural alternatives that he can take which will not cause other health concerns such as diabetes? Can l-theanine and gaba help his condition? L-theanine has been proven to cross the blood-brain barrier and stimulate alpha brain waves. Also, my son's thyroid is very low. Can't this also be playing a role in his anxiety?
thyroid level can play a role in anxiety. The diagnosis of mania is unrelated to anxiety, it is a mood disorder. When you say natural, the line is thin. Lithium is a naturally occurring element and is commonly used to treat mania. I am unaware of ANY over the counter product that will help - any taking him off his current meds. without proper supervision would almost certainly induce a seizure.

It sounds like you are not trusting the diagnosis. You might take him to see a psychologist for testing (although it is difficult to diagnose manic / depressive unless actively manic), so I think the best solution is a second opinion from another psychiatrist.
Customer: replied 7 years ago.

I have a few more concerns. I agree that another opinion may be necessary because my son's diagnosis continually changes. I believe that he probably had undiagnosed ADHD in high school (he is currently 29); he also took illegal drugs, predominantly marijuana, and then also suffered post-traumatic stress from a life-changing college incident. He never suffered depression - his bouts of mania seem to be panic attacks that have gotten out of control. Wouln't a complete physical be in order? The doctor only checks for his level of depakote. The medicine has helped, but is not the answer for healing. My son has tried talk therapy and EMDR, but has had little success. Do you think that hypnotherapy to get rid of emotional garbage might help? Also, proper nutrition and natural supplements - what would you do if this were your son?

ADHD often goes undiagnosed. In adulthood it often looks more like depression than ADHD and responds to antidepressants. Wellbutrin added in might help, and be of some help with weight and ADHD symptoms. If he is have bouts of mania and panic on his current medications, I to would question diagnosis too. Certainly a physical and labs are in order.

I would find a good psychologist to do a complete diagnostic test battery, to include neuropsychological testing. Psych testing is more sensitive to cognitive issues than brain scans in many cases. Then if something neurological is found, there is some direction.

What I am expecting is more of a PTSD disorder. SSRIs, like Prozac, seem to help with an alteration of the neural pathway that seem to be affected. Marijuana use is often so self medicate anxiety or mania. I am not a big fan of EMDR or hypnosis. Naturally good diet, exercise and nutrition is in order. I would not do natural supplements other than a good multivitamin. I think the crucial aspect is to find someone who can actually do the testing and take the time to get a reliable diagnosis. To discuss treatment without it is a wild goose chase.

The more information I get from you, the more the diagnostic possibilities change. Someone need to see him and have all the information.
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