Dear lotus, yes, medicines are highly imperfect and it is possible with any medication to have relapsing symptoms to varying degrees. The hope is that the odds of that happening are less on a medication than off of it. Triggers like sleep deprivation or alcohol/drugs can sometimes precipitate a manic episode but for the most part episodes don't have any obvious triggers and are just spontaneous biological events. Dr. G.View Thread
Dear Sarah, Loss of the need for sleep is often a fundamental sign of manir or hypomania, but it is not a "necessary" symptom; the broad concept that defines mania or hypomania is an unusually high energy state and speediness (of thinking, speech, activity) that lasts for at least a few days. Lamictal in general exerts a stronger effect against depressive than manic symptoms, and a dosage change would take at least a week or so to "readjust" in your system...so it's possible the change in medication could have led to the symptoms you're describing, but it's also possible you're having breakthrough symptoms simply due to the natural course of the disorder. Why was your doctor advising a downward dosing of the Lamictal, particularly if things have been stable? And what antimanic drug are you taking along with it?
A new hard scrotal mass should be examined by your primary care doctor, who can determine if it's just a varicose vein along the spermatic cord (ie, a varicocele) or a blood or fluid collection, or a different kind of mass, and whether there are any inguinal lymph nodes enlarged, and whether an ultrasound is warranted to help clarify the diagnosis.
Dear concerned mother, A lithium level of 1.0 mEq/L is therapeutic and a higher dose/level would likely only produce toxicity. There is no need for ongoing measurement of lithium levels apart from routine monitoring every 6 months unless there is reason to think he's noncompliant (a level will answer that) or if he develops new side effects (like tremor or unsteady gait) which could mean a level has somehow drifted up; otherwise there's no reason to think it would change. Generally speaking, if someone has had an incomplete response to therapeutic lithium after about 2-3 weeks, the standard next step is to add a second antimanic drug such as Depakote or Tegretol or any atypicalo antipsychotic. I can't tell you about his specific prognosis or what to expect since everyone is different, but the above steps would be a fairly standard approach, along with basic advice like avoiding all drugs and alcohol, maintaining a regular sleep schedule, being in a good psychotherapy, etc.
Provigil dosing goes up to 400 mg/day; I will often raise a patient's dose if its effects seem to be waning and there are no side effects (like nervousness, irritability or insomnia). It does not cause physical tolerance or withdrawal. It also does not raise blood pressure (e.g., while on an MAOI).
Dear Sarah, I can't speak for what every doctor would agree on, but there is general consensus in practice guidelines and the generally accepted standard of care that if someone has had even one severe and unequivocal manic episode, that warrants lifetime treatment for bipolar disorder, with rare exceptions (e.g., the episode was substance-induced or secondary to a medical problem). It may well be the case that if someone stabilized on lithium and had no subsequent episodes, that's because lithium was working and doing its job. (If your home got robbed in a high crime area and you then installed a security system and you didn't get robbed again in the next 10 years, does that mean you should get rid of the security system?)
Low stomach acid production, or hypochlorhydria, is a relatively rare phenomenon that can present with a variety of symptoms (gas, diarrhea, irritable bowel) that can be caused by a variety of problems ranging from excessive use of antacods to autoimmune diseases to stomach cancer to infections or inflammatory processes to certain vitamin deficiencies or anemias. GI symptoms should be evaluated by a physician to make a proper diagnosis and treat the underlying cause.
There is probably (?) a gastrointestinal link or website within WebMD -- sorry I'm not sure for certain -- where you can probably obtain more specific information than from here.
Dear nightblinkers, Parkinsonism is a movement disorder involving slowed movements and rigidity, and a tremor. It's usually dose-related, treatable with other medicines (or dosage reductions), goes away when an antipsychotic is stopped, and is separate from any possible cognitive side effects that antipsychotics can cause like mental slowing or dulling. Tardive dyskinesia is a very slow-onset, different type of movement disorder than usually begins with trouble controlling tongue movements, and can involve facial grimmacing or lip smacking. We usually try to minimize or stop antipsychotics if TD happens because TD can be permanent. Clozapine and Seroquel are among the least likely antipsychotics to cause either of these movement problems, and some research suggests that clozapine might possibly treat TD.