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Daniel Sheibley, MD
Daniel Sheibley, MD, Doctor
Category: Medical
Satisfied Customers: 1834
Experience:  MD Grad Jefferson Medical College 2009. Internal Med intern 2010 & Radiology residency 2011. Husband & father of two.
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Hi, I am diagnosed with bipolar disorder. In march 2012 I was

Customer Question

Hi, I am diagnosed with bipolar disorder. In march 2012 I was hospitalized after a psychotic manic episode. I was treated with a depot injection of piportil. Due to the unbearable side effects I stopped the treatment at the start of this year. I am currently on no meds. So basically I need some advice on what to do. Currently I'm in a state of depression where my mind feels really slowed down, I find it difficult to do simple tasks, I spend a lot of time sleeping, I find it difficult to concentrate and even hold conversations with people, I don't enjoy activities I used to like, the list goes on. However I do not feel suicidal only just fed up because I've felt like this for over a year now. Is medication the answer to my current problems if so what would u recommend?
Submitted: 3 years ago.
Category: Medical
Expert:  Daniel Sheibley, MD replied 3 years ago.

Daniel Sheibley, MD :

Hello

Daniel Sheibley, MD :

The mainstay of medication therapy for bipolar disorder is a mood stabilizing agent such as depakote (valproic acid) or lithium. That is the foundation of medical therapy.

Daniel Sheibley, MD :

Once the patient is tolerating one of those medication, if further medical therapy may be of benefit there are many other medications which can be added, but the specific one chosen may depend on the patient's other medical conditions and their psychiatric symptoms, i.e. if they remain depressed or of elevated mood.

Daniel Sheibley, MD :

The best therapy combines both medication and behavioral therapy. For example while undergoing medication treatment with a psychiatrist, also seeing a psychologist who can spend time discussing life and how the patient manages with their symptoms and can form coping strategies to help "naturally" mitigate their symptoms.

Daniel Sheibley, MD :

Additionally, some supplements are thought to help the patient with mood disorders, though taking any "natural" substance to treat a condition should be considered medical therapy. For example there are some reports, though varying in outcome, that fish oil supplementation can help with symptoms. Other studies more recently have shown that folate supplementation can help stabilize a patient's mood, however with regard to folate, the over the counter formulation does not cross the barrier between the blood supply and the brain and there is a prescription form of folate called L-methylfolate that has shown benefit and can cross that barrier.

Daniel Sheibley, MD :

So, between initiating medical therapy with a mood stabilizing agent, seeking both psychiatric (MD) and psychologic (PhD) counseling, "natural supplementation" under the approval of your physician, and self-education by reading quality sources about the condition (not just forums online which can be quite misleading) you can have the best impact on your life.

Daniel Sheibley, MD :

Also making sure to get quality sleep, setting a regimen so that you get to sleep at an appropriate and consistent time, avoiding substances such as nicotine and caffeine which can trigger changes in mood, getting exercise and eating a balanced diet.

Daniel Sheibley, MD :

If you have side effects with one medication there are always second line agents such as lamictal (which may not be as effective, but has a much less likely occurrence of side effects)

JACUSTOMER-a4pf05bp- : So being on a moodstabiliser is the answer then?
Daniel Sheibley, MD :

However valproic acid or lithium are the go-to mood stabilizers. Antipsychotics may help some patients but are generally added after the patient has been on a mood stabilizer for a while.

Daniel Sheibley, MD :

Yes as far as medication goes, a mood stabilizer such as depakote (valproic acid) or lithium is most highly recommended

Daniel Sheibley, MD :

There are other options, but generally patients end up being on one of those two. They have the most concrete evidence behind their effectiveness.

Daniel Sheibley, MD :

And in addition to medication, taking a holistic approach as well (not just popping a pill) will far and away give the best outcome to this life-long condition

Daniel Sheibley, MD :

Can I help you any further? you rated poor service

Daniel Sheibley, MD :

I wish to provide you with a satisfactory discussion

JACUSTOMER-a4pf05bp- : Would the moodstabiliser help with my concentration and energy levels
Daniel Sheibley, MD :

Yes. That is the place to start and reassess after you have been on in for a while to determine if adding another medication on top would help "tweak" your symptoms so that you feel as well as possible

Daniel Sheibley, MD :

Did I answer your question to satisfaction?

JACUSTOMER-a4pf05bp- :

no

Daniel Sheibley, MD :

How else can I help with this question?

JACUSTOMER-a4pf05bp- :

i have been on a moodstabiliser in the past (epilim) and i've not been able to function properly. it seems to only make me more depressed

Daniel Sheibley, MD :

That is where additional medications come in. After the mood is stabilized other medications such as one from the class of atypical antipsychotics (seroquel etc for example) can help reduce the depression.

Daniel Sheibley, MD :

Traditional SSRI medications are not recommended for depression in patients with bipolar as they can destabilize them into an episode of mania.

Daniel Sheibley, MD :

But the key is a mood stabilizer and then adding on a medication such as a lamictal, a SNRI or atypical antispychotic (a class of newer antipsychotic medications) to further improve symptoms

JACUSTOMER-a4pf05bp- :

the more medications i take the more horrible side effects i would suffer from

Daniel Sheibley, MD :

If you are against taking medications, then still seeing a psychiatrist but going a more natural approach with supplementation such as folate and fish oil as I mentioned as well as regular psychologic counseling may be the best alternative fit for you, though not all medications give patients side effects. Just because you had ones with a certain medication does not mean you will have them with another.

Daniel Sheibley, MD :

Medications are not one size fits all

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