Thank you, thank you, thank you for all of your words and…

Question

Thank you, ***** ***** thank you for all of your words and suggestion. My
husband and I have discussed your answer and will definitely try to work through
this time while supporting our own needs for decent treatment. But one last
question...!
My biggest concern is showing him that we won't tolerate the silent treatment
and pouting, he is likely to either forget his medications or stop taking them
"to show us" that he can do what he wants...basically his normal stance. He
lives over an hour away from us, still living in the home he grew up in with
helpers coming in 4 times a week for 3 hours each time. They are not nurses, but
general employees who can help him with normal day-to-day needs, cleaning house,
grocery shopping, doctor appointments and friend to talk to. They cannot give
him medication, but only suggest. And since they're only there M-W-F-Sat, there
are a few days that he's on his own to remember his meds.
Previously he had to take one pill when he woke up. The same pill around 4PM. A
stabilizer around dinner time and a relaxing pill before going to bed. The 4PM
was the hardest to remember for him to take. We have a pill holder setup with
times on the holder. But as you can imagine, most people have a hard to
remembering to take pills at various times of the day without any of his issues.
So, we felt like he was basically setup to fail. So, we talked to his MD to
discuss simplifying his med schedule. He agreed and this is what he's on now:
Bupropion (bipolar [/topics-bipolar-mental-health/]) 1 pill, 300mg pill when he
wakes in the morning.
Lamotrigine (mood stabilizer) 1 pill, 150mg with dinner.
Simvastatin (cholesterol) with dinner
Zyprexa (relaxer) 1 pill with dinner
He was spiraling down because he'd forget the 4PM pill and then would fall
asleep before taking the Zyprexa. Of course, he didn't sleep well at night since
he would fall asleep most of the day...all out of wack. With the new schedule
(above), he only had to remember 2 times, when he wakes up and when he eats
dinner. The doctor gave both doses of the Bupropion when he wakes up AND
increased the Lamotrigine from 100 mg. to 150 mg. It really seemed to be helping
his mood, partly because of the chemistry, but also because he finally felt
successful at it.
I did [/topics-did/] confirm that he could take the Zyprexa at dinner (and not
before bed) and was told this schedule should be fine. He really fought taking
something that would cause his to fall asleep earlier in the evening (before
1AM) because he would need to stay awake when he becomes a DJ at his own
club...I told him when that happens, we could talk to his doctor about changing
the meds...he finally caved and worked with us.
So, if we "walk away" from him each time he mistreats us, he rebells and stops
taking pills, he's going to spiral. How would you suggest we help him "learn"
but also keep him safe and on the right track?
Finally, I'm a little concerned because we are beginning to catch him in lies
he's telling. We haven't confronted him on them yet because I don't want to come
across as attacking...but never felt he was a liar, basically the opposite as
overly honest. But I'm beginning to fear that he's learning that it's easy to
get away with lying and it might be getting worse.
These will be our last questions for now. Thank you again for all of your
detailed information. You've been VERY helpful.
Lisa

Dr. Kaushik · Accepted Answer

Dear *****,
While i cannot intervene in his doctor's prescription but i must say that
bupropion's use in his case is extremely redundant, in fact some psychiatrists
consider this drug to cause mood switching between depression and mania but this
is still inconclusive and lacks evidence but i say why to use a drug aka
buproprion which has controversial credibility in managing bipolar symptoms and
may be denting his chances of recovery. And anyways zyprexa ( i.e is olanzapine
) and lamotrigine are the two main drugs required for his recovery from bipolar
symptoms.
As far as difficulty in adherence to the drug regime is concerned, it is quote a
common scenario of occurrence in such patients, however what can be done as a
solution to this is to use an alternative option the long acting depot
injections of zyprexa ( zyprexa relprevv ) which is basically the same drug
given in injection form only once in 2 weeks or 4 weeks so that the need of
daily intake of oral medication is bypassed without having to compromise on the
efficacy the same drug was providing orally. So you can discuss this strategy
with his doctor and see if it can be used in his case. This depot zyprexa
injection is approved for use in schizophrenia [/topics-schizophrenia/] but also
it can be used in bipolar patients at the discretion of the prescribing
psychiatrist.
So to summarize his present drug regime can be revised and present in this below
manner.
1) Long acting depot injection of zyprexa ( zyprexa relprevv ) to be given once
in 2-4 weeks.
2) Lamotrigine at dose of 150-300 mg / day once at night.
3) Simvastatin as usual.
4) Stop zyprexa oral medication and stop bupropion.
So basically he will be left with only 2 medications both of which can be taken
at night time so this will take some pressure off him to remember the different
timing of drugs plus it will maintain his compliance with drugs and ease your
tension as well while maintaining his recovery from the drug.
I am sending you two important links which you must go through to learn more
about able drug options in his treatment and which you can confidently discuss
with his psychiatrist for seeking best treatment plan.
-- http://www.medscape.com/viewarticle/545825#vp_2
--
http://www.nps.org.au/publications/health-professional/nps-radar/2009/december-2009/olanzapine-depot
I hope this sums it up for you.
Have a happy and prosperous New Year. You generous folks defintely deserve that.
God bless.
It was a pleasure talking to you. If you have an additional query, kindly come
back to this question and ask it. for future queries, you may address the
question directly to me such as For Dr. Kaushik and the question will be
directed to me.
Warm regards

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