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574118 tn?1305135284

seeing my pdoc today-any ideas

probably i am BP1, still i can't tell because depression is still a big issue but under an antidepressant i switch easily. my drugs are:

seroquel 50mg (AP)
risperidone 1mg (AP)
stelazine 1mg (typical AP)
stablon (AD) smaller dose

since my 1st mania 4 years ago and things are getting worse but more or less i function - of course badly - but life is going on. Until 3 months ago when after a swine flu i became unstable and oscillating more frequently. my family started to believe that things went out of control and that the above meds need to be changed and that i should be put on a proper MS. i have thought of 3 possiblities to discuss with my pdoc today:

1. to take seroquel only as a monotherapy and raise the dose to 100-150 hoping to lift depression and act as a mood
    stabilizer while cutting off all the other AP's. Adding or not an AD depends on the seroquel helping or not.

2. to stop all the AP's except a minor dose of seroquel 25-50mg say + lithium + and AD if lithium proves no good for
    depression

3. to take another MS like valproate or gabapentin (the last is weak)

i really am running out of ideas and i don't think the pdoc can propose other choices - perhaps he can-. of course there remains another AC like lamictal or tegretol or trileptal  Of course each of the above choices has its shortcomings, for instance in 1 i can keep increasing my seroquel with no use also risk of TD and bad withdrawal later

yesterday i had severe suicidal thoughts and hearing voices ordering me to cut my throat off (i reduced my AD so probably i am depressed), my parents got alarmed and informed the pdoc that my BP is to be taken seriously this time because not that things don't improve but in fact deteriorate so we need a strong intervention instead of the trivial sedatives i'm taking, i.e. i need an MS like all other human beings

can you think of the above choices and propose one or suggest others. of course it depends on the pt, but i mean which sounds a more logical approach
thanks a lot
ezz
3 Responses
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574118 tn?1305135284
thank you very much ILADVOCATE. I knew that you will respond. This is why i didn't turn my PC off.

Xila31: thank you for boosting my morale. incidentally this morning i am better off. will keep you informed
Helpful - 0
585414 tn?1288941302
Well although a psychiatrist could make a conclusive decision from what I know one antipsychotic at a working dose is more effective then 3 at a sublinical dose and there is less of a chance of long term side effects as well. Seroquel didn't even begin to work for me until 300 mg but and I believe that's the standard starting effective dose through only a psychiatrist would understand this in full. As to whether an adjunct mood stabilizer is needed or anything else you could discuss that with your psychiatrist as well.
Helpful - 0
952564 tn?1268368647
Good luck at the doctor, ezz!

I'm sorry you are not well right now. I hope that you start feeling better soon, okay? I wish I knew what to say except that you're not alone. Don't forget! You have friends all over the world who hope you are better soon, okay?
Helpful - 0
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