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Dr. Bob is Robert Hsiung, MD,
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Posted by psych chat on October 24, 2009, at 23:35:37
What is the usual initial course of treatment for a young man with bipolar depression who has never seen a psychiatrist before?
I've suspected my son has been BP for some time now. He's 21. He was diagnosed with ADHD many years ago, but over the past 4 years or so--has lacked energy, motivation, happiness. He used to be 'silly' and fun-loving; for the past couple of years, he has totally changed. He just told me he hasn't felt 'normal' since 8th grade. I feel so bad-it is sooooo difficult for him to talk about this. His friends have never experienced mental health issues. He is so uncomfortable talking about this..but he opened up a bit tonight....
Since he has no health insurance (and is not motivated to go on meds either way) I'm wondering what initial treatment has proved successful for those in a similar situation? I don't want to see him suffer numerous trials as I have, and am interested in hearing input from those who have had initial, successful trials for the treatment of bipolar depression.
Thanks :)
Posted by Phillipa on October 25, 2009, at 0:22:57
In reply to Initial treatment for 1st time bipolar depression, posted by psych chat on October 24, 2009, at 23:35:37
I'm sorry. Will he see a therapist or doc? If not can't force to take meds. What are his symptoms? Do you feel he's bipolar or diagnosed? Love Phillipa
Posted by zzzz7 on October 25, 2009, at 0:52:43
In reply to Initial treatment for 1st time bipolar depression, posted by psych chat on October 24, 2009, at 23:35:37
I'm really sorry to hear about this. It must be really hard for a parent to see a child suffer with mental illness.
Is the question concerning non-drug treatments for BP? That's difficult. Getting enough sleep and exercise can help reduce the onset of mania, but it's really hard without drug treatment to manage many BP cases well.
If you can get him to try medications, first-line drugs include anticonvulsants (like Lamictal) and anti-psychotics (like Seroquel).
You or your son might find Kay Jamison's _An Unquiet Mind_ helpful.
She's a researcher in neuroscience and has BP herself.
Good luck to you.
You might read or give him
Posted by bleauberry on October 25, 2009, at 6:53:53
In reply to Initial treatment for 1st time bipolar depression, posted by psych chat on October 24, 2009, at 23:35:37
I don't hold much faith in the so-called labels of mental illnesses since: 1)Most of them overlap somewhat, 2)Subjective...will vary from doctor to doctor, 3)Are just names for idiopathic clusters of symptoms that can respond to a wide variety of agents, 4)Provides only basic ideas for a starting point.
I don't see the bipolar component in your post. I'm not sure where that conclusion came from. Assuming it is true, then...
1. Lithium orotate from online or health food stores for mood stability, brain neuron protection and rejuvenation. Magnesium supplementation of at least small to modest doses is a good idea, as long as it doesn't worsen the depression.
2. Rhodiola Rosea (either the Ameriden brand or the Mind body Spirit brand) for the depressive symptoms.
3. Get the B vitamins separately, not a complex with all of them, and start experimenting with each. They can make a huge difference in many people. At the very least, get some B complex. Individual ones are better though, so you can judge what is doing what. Most potential likely from B6, B12, Niacin, Folate.
Is he still on ADHD meds? If not, his brain may be lacking in the chemicals that those meds were supporting, which would call for supplementation with Tyrosine 150mg to 1000mg, if the Rhodiola alone didn't do the job. If he is still on them, then he may need 5htp instead, 10mg to 100mg.
This will save you a ton of money and keep you out of the expensive doctor/meds roller coaster ride. I think it makes sense to avoid experimental big guns if you don't need tham. At this point, you don't know if you need them. So it would be foolish, in my mind, to go straight to them without trying easier, cheaper, healthier things first.
Whatever you do...doctors or not...will be experimental. There are no surefire foolproof methods to fix any psychiatric diagnosis. It is experimental. I mentioned Rhodiola because it has a large body of evidence supporting it, much stronger than the popular St Johns Wort. (which by the way, in combination with the lithium and lemon balm, would be another worthy consideration)
However, this is important. If he reaches a point of suicidal thoughts, anything be tried up to that point needs to take a back seat while he is brought to prompt medical attention, either a doctor or the emergency room. If you try the best you can with the above suggestions and they fail...which I doubt they have a strong chance of failing...then, and only then, turn to the more expensive yet equally experimental world of psychiatry medications.
While immediate symptom control is the present goal, you kind of have to look back in history to where these symptoms started and try to ask, "What happened then?" "What changed?" "Why did these symptoms begin at that time?" There is a reason. It wasn't the moon or the tides. Do you live near ticks? Did he have amalgam fillings installed in his teeth? Detective work. What changed between the 7th grade and the 8th grade? Very important question.
Posted by psych chat on October 25, 2009, at 20:40:19
In reply to Re: Initial treatment for 1st time bipolar depression » psych chat, posted by Phillipa on October 25, 2009, at 0:22:57
Hi Phillipa,
We discussed symtpoms and both of us think he may be bipolar. I guess only a MD can say for sure.
Yes, he's an adult and will have to make a choice. He saw me suffer negative effects from med trials, and is against it overall.
Posted by psych chat on October 25, 2009, at 20:42:07
In reply to Re: Initial treatment for 1st time bipolar depress, posted by zzzz7 on October 25, 2009, at 0:52:43
Thanks for the info. I'll take a look at your link and print that out for him (or is this a book??), might be good for him to get a view of someone other than Mom right now.
Posted by psych chat on October 25, 2009, at 20:46:03
In reply to Re: Initial treatment for 1st time bipolar depression, posted by bleauberry on October 25, 2009, at 5:53:53
It seems the only things that changed were that he started having serious girlfriends in 9th grade.
I see how symptoms overlap. Today I did go to the health food store and buy a neurotransmitter supplement - its choline, taurine, l-tyrosine, l-glutamine, L-carnitine, PS/phosphatidylserine, and alpha lipoic acid. We are both going to try it. Thanks.
How did these facebook and twitter icons end up on all the posts?????
Posted by Phillipa on October 25, 2009, at 21:01:44
In reply to Re: Initial treatment for 1st time bipolar depression » bleauberry, posted by psych chat on October 25, 2009, at 20:46:03
That's exactly what I also wish to know does this mean someone can post what we write other than ourself on those sites? Phillipa in disguise
Posted by zzzz7 on October 26, 2009, at 5:21:49
In reply to Re: Initial treatment for 1st time bipolar depress » zzzz7, posted by psych chat on October 25, 2009, at 21:42:07
Hi,
Yes, that's a book.
Good luck.
Posted by zzzz7 on October 26, 2009, at 5:24:31
In reply to Re: Initial treatment for 1st time bipolar depression » bleauberry, posted by psych chat on October 25, 2009, at 21:46:03
You might want to be careful with those supplements given that this is likely BPD. Not that I'd expect a problem, but it's not impossible.
Posted by Rosy Crucifiction on October 26, 2009, at 12:09:09
In reply to Initial treatment for 1st time bipolar depression, posted by psych chat on October 24, 2009, at 23:35:37
Have you considered NAC? It's inexpensive and has shown some success. There's a thread here:
http://www.dr-bob.org/babble/20080727/msgs/843636.htmlHere's a study:
Abstract
BackgroundTreatment-resistant subthreshold depression is a major problem in bipolar disorder. Both depression and bipolar disorder are complicated by glutathione depletion. We hypothesized that treatment with N-acetyl cysteine (NAC), a safe, orally bioavailable precursor of glutathione, may improve the depressive component of bipolar disorder.
MethodsA randomized, double-blind, multicenter, placebo-controlled study of individuals (n = 75) with bipolar disorder in the maintenance phase treated with NAC (1 g twice daily) adjunctive to usual medication over 24 weeks, with a 4-week washout. The two primary outcomes were the Montgomery Asberg Depression Rating Scale (MADRS) and time to a mood episode. Secondary outcomes included the Bipolar Depression Rating Scale and 11 other ratings of clinical status, quality of life, and functioning.
ResultsNAC treatment caused a significant improvement on the MADRS (least squares mean difference [95% confidence interval]: −8.05 [−13.16, −2.95], p = .002) and most secondary scales at end point. Benefit was evident by 8 weeks on the Global Assessment of Functioning Scale and Social and Occupational Functioning Assessment Scale and at 20 weeks on the MADRS. Improvements were lost after washout. There was no effect of NAC on time to a mood episode (log-rank test: p = .968) and no significant between-group differences in adverse events. Effect sizes at end point were medium to high for improvements in MADRS and 9 of the 12 secondary readouts.
ConclusionsNAC appears a safe and effective augmentation strategy for depressive symptoms in bipolar disorder
Posted by floatingbridge on November 1, 2009, at 19:22:50
In reply to Suggested treatment -1st time bipolar depression, posted by Rosy Crucifiction on October 26, 2009, at 12:09:09
And NAC is neuro protective--am I correct?
Posted by floatingbridge on November 1, 2009, at 19:26:58
In reply to Initial treatment for 1st time bipolar depression, posted by psych chat on October 24, 2009, at 23:35:37
Pysch Chat,
I'm sorry to hear about your son. That must be painful; however, I sense you are strong and will be able to deal with this successfully.
Years ago, I was diagnosis as bipolar. At that point, I was put on depakote. I tolerated it well. I don't know how it is for males--for women it has ben shown to signal an increase in abdominal fat. I also think it is relatively cheap.
blessing and good thoughts for your son,
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