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Mental Health (Expert Forum)
Neurontin, Lexapro, Seroquel and psychotic phase
Answered by
Roger Gould, M.D. - Mental Health, Wellness
Questions posted in the Mental Health forum are being answered by Dr. Roger L. Gould, author of the Mastering Stress and Depression program and affiliated with the UCLA. Department of Psychiatry. Topics covered include anger, attention deficit disorder (ADD), bipolar disorder, dementia, electroconvulsive therapy (ECT), learning disabilities, memory, obsessive compulsive disorder (OCD), panic, personality disorders, phobias, post-traumatic stress disorder (PTSD), schizophrenia, stress, transitions, and work problems.
Neurontin, Lexapro, Seroquel and psychotic phase
by casey44, Mar 23, 2004 12:00AM
A female relative, 81, was on lithium for two decades and had no psychiatric hospital. during that time. In 2003, she became toxic and was changed to Neurontin (300mg pm) and Exelon 1.5 mg am/pm. This occurred a month before death of husband of 50+ yrs. She did well for 6 months -was more mentally clear and focused than for sev. yrs. Lived independently. Psych. said he doubted that she had Alz, but didn't want to remove the Exelon bc she was doing so with w/the Ex./Neuron. combo. In Dec, a neurologist prescribed Elavil for sleep. That was ok for about 3 weeks. Then, she became very anxious about a neighborhood crime and (uncharacteristically) doubled her Neurontin, Exelon and Elavil one night. This resulted in mania -- -- agitated and talking almost nonstop, recalling events of years past -- many involving instances of social anxiety. Family hired an evening sitter. Her psychiatrist immediately stopped the Elavil and added Xanax and Seroquel(25mg). The Xanax was used only for a week or so. She improved slowly and steadily. The sitter was discontinuted.
A few weeks later, she became deeply depressed; said she wanted to kill herself. She didn't have a suicide plan; seemed to be expressing a desire to die, as opposed to a true intention to end her life. She was hospitalized that evening. Lexapro was added to her Neurontin/Exelon. Seroquel increased from 25mg to 100mg. During hospitalization, she exhibited a little delusional behavior about other patients.
Within a week of her discharge, she was becoming increasingly paranoid and delusional. People trying to hurt her, entering her apartment in her absence, trying to poison, installing listening devices, etc.
Family members noted the behavior began with her hospitalization and asked if the meds could be part of the problem. Her psych. felt strongly that she was not taking her medications bc he had increased her antipsychotic med (Seroquel), but was showing signs of psychosis. Seroquel to 200 mg. Family began to monitor meds. Within less than 24 hours, the psychosis had increased. Within 36 hours, it was clear she needed to be hospitalized again. She was paranoid and delusional. This was 11 days ago. She continues to be hospitalized with this regimen: Seroquel 300-350 mg p.m.; Neurontin to 900 mg (600 mg am and 300 mg pm); Exelon 1.5 mg am/pm. Lexapro 10 mg pm. And two or three days ago, Namenda 5 mg was added.
She finally appears to be improving, but still has some psychosis and isn't ready to go home. She also has wet her bed, which has never been a problem.
Her other meds are Accupril and clonidine for blood pressures; glucophage for blood sugar and Prevacid. Clonidine is new as of Dec03.
In Dec, patient was driving and alert. Now facing assist. living. We've read that neurontin can have immediate great results for bipolar, but often is ineffective w/in a year. Today's news about antidepress. is another concern. Considering geriatric psychiatric specialist. Your thoughts?
A few weeks later, she became deeply depressed; said she wanted to kill herself. She didn't have a suicide plan; seemed to be expressing a desire to die, as opposed to a true intention to end her life. She was hospitalized that evening. Lexapro was added to her Neurontin/Exelon. Seroquel increased from 25mg to 100mg. During hospitalization, she exhibited a little delusional behavior about other patients.
Within a week of her discharge, she was becoming increasingly paranoid and delusional. People trying to hurt her, entering her apartment in her absence, trying to poison, installing listening devices, etc.
Family members noted the behavior began with her hospitalization and asked if the meds could be part of the problem. Her psych. felt strongly that she was not taking her medications bc he had increased her antipsychotic med (Seroquel), but was showing signs of psychosis. Seroquel to 200 mg. Family began to monitor meds. Within less than 24 hours, the psychosis had increased. Within 36 hours, it was clear she needed to be hospitalized again. She was paranoid and delusional. This was 11 days ago. She continues to be hospitalized with this regimen: Seroquel 300-350 mg p.m.; Neurontin to 900 mg (600 mg am and 300 mg pm); Exelon 1.5 mg am/pm. Lexapro 10 mg pm. And two or three days ago, Namenda 5 mg was added.
She finally appears to be improving, but still has some psychosis and isn't ready to go home. She also has wet her bed, which has never been a problem.
Her other meds are Accupril and clonidine for blood pressures; glucophage for blood sugar and Prevacid. Clonidine is new as of Dec03.
In Dec, patient was driving and alert. Now facing assist. living. We've read that neurontin can have immediate great results for bipolar, but often is ineffective w/in a year. Today's news about antidepress. is another concern. Considering geriatric psychiatric specialist. Your thoughts?
Doctor's Answer
by Roger Gould, M.D., Mar 24, 2004 12:00AM
, Mar 24, 2004 12:00AM
I like your last idea the best, a geriatric psychiatrist. There are so many possible causes for what you describe that only a thorough exam and analysis will make a difference. It is posssible that all of the medications are causing problems, and an experiment of removing them one by one down to minimum doses is in order. Its also possible that the opposite is true...she has an active underlying disorder that only medications can treat.
beach-***@****
and thanks!
deb