Apart from providing services that are hard to obtain as an outpatient (like ECT), hospitals mainly provide safe haven in a crisis. Rarely do the doctors have enough time to do meaningful and thoughtful evaluations about diagnosis and treatment, and sometimes the medicine changes that occur in the hospital are hasty, unhelpful, or counter to what the outpatient doctor might do. Medicines, as you know, also usually take many weeks to work, so nobody realistically expects that 1 week of a medicine change in the hospital does anything pharmacologic. If someone is having uncharacteristic suicidal thoughts, that needs to be addressed as part of the overall treatment plan. In a crisis, the ER can provide safe haven. If someone has longstanding suicidal thoughts -- not just a distinct symptoms during a depressive episode -- that's often a very different sort of problem which may require behavior contracts and more extensive involvement with other treaters as part of a "team" approach. Dr. G.View Thread
Dear Debbie, It may be that one or both of the medicines are causing perceptual changes, or feelings of unreality. Might be best to ask your doctor about stopping one or both and then consider this to be an unusual medicine side effect. Dr. G.View Thread
Saphris treats mania but isn't known to cause it. The effective dose found in the mania studies was 20 mg/day, and so 5 mg may be trivial in its effect. It has no known effects on depression symptoms. It's typically taken twice a day to maintain a steady state. If he is taking it irregularly such as you describe, it will probably have a diluted effect if any.
Dear bebecgc, Not especially. TMS remains a treatment option for major depression but its effect is inferior to that of ECT and it is not as well studied in bipolar as unipolar depression. Dr. G.View Thread
Dear Apmoraes, Rapid cycling means 4 or more separate episodes per year, not mood changes from one day to the next. Mood changes from one day to the next aren't diagnostic of anything and could reflect a wide range of problems. It's true that for some bipolar patients antidepressants can cause more frequent episodes over time, but that isn't what you're describing. Brain zaps and anxiety and sleep problems could well be signs of ongoing SSRI discontinuation. In my own patients I often simply restart an SSRI to see if the suspected disontinuation symptoms go away. More info on this can be found at: http://psychrights.org/research/Digest/CriticalThinkRxCites/rivas-vazquez.pdf The sore throat and muscle cramps and pain don't sound likely related to Seroquel. None of this sounds like TD, which as I mentioned is rare and occurs many months or years into treatment, if at all. Latuda is another atypical antipsychotic that can also treat bipolar depression, has less sedation than Seroquel. It may be useful if indeed you have bipolar depression, and might be useful for agitated depression if paired with an SSRI, but may do nothing if you have something altogether different from bipolar disorder, such as SSRI discontinuation symptoms. Dr. G.View Thread
Nobody could give you a diagnosis over the internet without doing a proper in-person psychiatric evaluation, so let me just offer some general thoughts. The diagnosis of bipolar disorder requires having at least one manic or hypomanic episode, defined by a period of excessive energy, fast thinking, fast speech, overactivity, and an excessively euphoric or irritable mood. "Mixed" episodes refer to manias that also involve symptoms of depression, or, episodes of depression that involve at least several symptoms of mania. Rapid cycling means that over a 12 month period, there have been at least 4 episodes (so, rapid cycling doesn't describe "an" episode -- it describes many episodes per year). Seroquel treats mania or depression in people with bipolar disorder but by itself (that is, without an antidepressant) hasn't been shown to treat depression in people who don't have bipolar disorder. It also has some antianxiety properties in general, though it can be very sedating. If citalopram was effectively treating depression and anxiety for 5 years, it's unlikely that it would suddenly cause problems, although stopping it could both bring on some discontinuation symptoms (usually, nausea, headache, dizziness, restlessness, insomnia), or a rebound worsening of depression or anxiety. Discontinuation symptoms wouldn't likely persists for 7 months, though. If a patient of mine had mania symptoms like the ones I described above then I would not prescribe them an SSRI like citalopram, but if they were not manic then I would have little hesitation to add citalopram back to the regimen. Tardive dyskinesia is a slow-onset movement disorder that can arise after many many months of treatment with an antipsychotic drug such as Seroquel, so it would not be an expectable result of relatively short-term treatment. I hope these general comments are of some help as you and your doctor work on the best plan for your treatment. Dr, G.View Thread
Nowadays, most psychiatrists hate to have their patients go into the hospital because stays are ultra short, medicines often get changed too quickly and arbitrarily and no real treatment occurs apart from putting someone in a safe place if they don't think they can take care of themself. If you're having trouble distinguishing reality from nonreality then antipsychotic medicines such as seroquel (which also treat depression) may be worth considering with your doctor. I wouldn't hesitate to tell your doctor what's going on ...hospitalization often is more likely when someone DOESN'T communicate.
Dr GView Thread