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DrRussMD
DrRussMD, Board Certified MD
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Experience:  Board certified Internal medicine and Integrative medicine. Many years of experience all areas.
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My husband had a breakdown in August 2013 he was prescribed

Resolved Question:

My husband had a breakdown in August 2013 he was prescribed Sertraline 150 mgs and then had 150 mgs of Lyrica added in two weeks later for anxiety, but also because he had to go away with work and it was felt this would help.
When he returned 6 weeks later he had had a complete change in personality.
I informed the CPN and GP of my concerns, my husband and I are both health professionals, things are now at breaking point he has had an affair disowned his family and believes he is 25 again and is actually 53.Has the lyrica caused this he fits many of the side effects.
He had 3 short previous episodes of depression which were found to be reactionary and that it was more his personality trait, he was treated with minimal doses of ani depressants with good effect,last time 19989
Submitted: 2 years ago.
Category: Medical
Expert:  Dr. SH replied 2 years ago.

Dr. Shahzad MD :

Hi there. Thank you for your question. I will be helping you out with your queries

Dr. Shahzad MD :

welcome

Dr. Shahzad MD :

Can you elaborate his state of mind a little more for me.

Customer:

Can you consider if I am correct in thinking that he may have had a personality change due to the lyrica, he has become a stranger at home, irritable, erractic behaviour staying away fro home without explanation, memory loss, confusion, changes in sexiual behaviour, changes in self perception I was with him in August and Sept when he attended the cpn he would not let me out of his sight, he did appear to have insight then but none now, he feels we have abandoned him he wants control and now has had an affair, which is so far removed from .the father and husband that he is, he has been assessed previously and they aid he had a personality that didnt cope well with major life events, our son got his A level results prior to his breakdown and he felt helpless

Dr. Shahzad MD :

Yes it could be a side effect of medications that he is on surely.

Dr. Shahzad MD :

Is he following up with a psychiatrist?

Customer:

The psychiatrist has agreed if my husband consents to review his case and consider the medication , but I am so concerned given his position that he might refuse he is loving this new him as it were , my husband was able to chose not to attend the psychiatrist in August and chose to speak only to a cpn of his choice, he has worked as a Doctor the whole time through this and I fear not only for our family but his job and credibility .I have no idea who to turn to for advice

Dr. Shahzad MD :

I understand that you are going through a tough time.

Dr. Shahzad MD :

I think that a reduction in the dose of his medications may be something that may help but that can only be done under the supervision of his psychiatrist.

Customer:

So what should I ask the psychiatrist?

Dr. Shahzad MD :

You should mention all the symptoms that he is experiencing and if these could be side effects of the medications.

Dr. Shahzad MD :

The change in personality should be discussed in detail.

Customer:

If this is a side effect and they decide to reduce or withdraw the medication , will my husband understand that the actions of the last few weeks were symptoms of the medication? Will the reality of his actions be understood by him , that we as a family will support hi through this?

Dr. Shahzad MD :

I understand that this is a tough situation and should be handled with extreme care and you should discuss his changes in personality with him softly or carefully.

Customer:

I am unable to contact him and he does not want us to be in touch as I found him out last week after he went missing for 41 hours and then by chance found him out , he had blamed us for having a few days away at half term , he booked our travel but had no recollection of our emaila nd text trail to the detail of where we were staying. but he lied to everyone and caused major distress, I would not consent to police being informed despite pressure from his heirarchy,

Dr. Shahzad MD :

I understand that it is a tough situation.

Dr. Shahzad MD :

But the only way forward is counseling him.

Dr. Shahzad MD :

Trying to talk to him.

Customer:

if he has bpd could the lyrica be more likely to cause the side effects?

Dr. Shahzad MD :

No

Dr. Shahzad MD :

It should not affect a person negatively if he has BPD.

Customer:

if he has ptsd could that make a difference , they have mentioned a life changing event and he that he has control issues and avoidance issues?

Dr. Shahzad MD :

Yes PTSD is something that could cause such symptoms, I agree.

Dr. Shahzad MD :

I personally think that if you can somehow make him go to the psychiatrist to discuss all these options it would be great.

Dr. Shahzad MD :

I think that we need to get to the root cause of this problem.

Customer:

Can you tell me what questions I need to ask?

Dr. Shahzad MD :

This does require a very patient psychiatrist who is able to listen to him and you.

Customer:

That does not answer my question.

Dr. Shahzad MD :

The most important question would be about the daignossi.

Dr. Shahzad MD :

diagnosis

Dr. Shahzad MD :

The psychiatrist needs to get to the bottom of whats causing this to happen.

Dr. Shahzad MD :

It could be side effects of the medications.

Dr. Shahzad MD :

It may be due to the mental state that he is in

Dr. Shahzad MD :

So the questions that you should is:
1. Could his medications have anything to do with this?
2. Could his symptoms be due to PTSD?

Dr. Shahzad MD :

3. What else could cause such symptoms? Could it be BPD?

Customer:

They told me they had a working diagnosis, not ptsd , and that he was in remission of his depression , prior to the events of last weekend and now under pressure from me and his previous GP they are considering their options, I understand the proberty isues but I am at a loss of how to approach this, lease help/

Dr. Shahzad MD :

Depression is a possibility but I also think that an opinion from a different psychiatrist, just to be sure, would help.

Dr. Shahzad MD :

Because his other symptoms do not fit in very well with depression.

Customer:

How do I get that given he is military?

Dr. Shahzad MD :

I understand that would be tough but a consultation with a private psychiatrist may well be worth it.

Customer:

How can I get that without his consent? I have suggested that they consider his previous histories and treatment very different from this approach. I think an independent assessment could be good but they would need to understand PTSD, my husband had a very bad tour of AGHAN 2012, and he has expressed his thoughts with me but am unsure if he has really addressed them with the cpn who is a lower rank , I am in an impossible position, if I whistleblow he may lose his job , if I do not do something we have lost a husband and a dad to 4 teenagers.

Dr. Shahzad MD :

It really is a tough situation, I agree.

Dr. Shahzad MD :

Is it possible for you to discuss these things with him?

Dr. Shahzad MD :

I think that if you discuss these things with him in an indirect way that may help.

Customer:

No he has move out of marital home on Tuesday once challenged by me with minimal evidence of an affair, he even got his friemd to tell us he had left usand refuses to speak to us and that is completely out of character we are known as Team S....., and our family motto is Family first.

Customer:

How can you do it indirectly?

Dr. Shahzad MD :

Really tough then.

Dr. Shahzad MD :

You would have to talk to someone who is close to him now.

Dr. Shahzad MD :

Do you know someone else who is close to him now you can talk to him?

Customer:

He is lying to everyone he has not given any two people the same answer and I feel he is living moment to moment, he is being blasee with colleagues, saying some minor marital issues at home nothing else but one colleague has realised the severity of the situation.

Customer:

He is living in an unreal world, by your answers I realise that this is pointless, I am never going to convince them tomorrow of my concerns and the military animal will will swallow us up as a Marital issue , it is definitely not.....

Dr. Shahzad MD :

It really is a tough situation given that he is in the military and given the nature of his job.

Dr. Shahzad MD :

His symptoms are most likely not only due to depression and BPD is a real possibility here.

Dr. Shahzad MD :

I think that if you wish to save your relationship you will have to take some tough decisions.

Customer:

Thank you the first possible break through , I provided a comprehensive of his history, he could lie for Ireland itself, he has kleptomania minor, Private eye and greetings cards, vulnerability is an issue and a controlling adult in his life his father, who sadly is very unwell at present with an unknown degenerative cerebellar defect aged 79 , What decisions should I take ? I bounced the ball into his court on Tuesday when I asked him to stay away for the night given that the kids had mock exams, he did this and then I said I would proceed at his pace, nothing has happened he has not communicated and neither have we as a family , except we had a call last night from his mobile an iphone which according to my kids , young adults that you cannot accidentally dial,

Dr. Shahzad MD :

This is a really tough situation considering that you your relationship and your family is at stake.

Dr. Shahzad MD :

By tough decisions I mean that you should discuss this directly with his psychiatrist in the military about his behaviour.

Customer:

Yes , I am a strong wife because I have to be to manage life without a husband at least 3 months every year and 7 months in 2012 .the psychiatrist is similar rank to my husband and my husband does not rate him.

Customer:

can my husband refuse to reduce his medication given that he likes the effect/

Dr. Shahzad MD :

Yes he can refuse the reduce the dose of medications but if his doctor wants his dose to be reduced and reduces the dose then he will get what his doctor has prescribed.

Dr. Shahzad MD :

So his doctor has the final word in all this.

Customer:

Guess who his doctor now is? yes his psychiatrist!!!! his GP was a family friend , she gave him up as apatient as this unravelled,

Dr. Shahzad MD :

oh okay

Dr. Shahzad MD :

Anything else that you would like to ask?

Dr. Shahzad MD :

or add?

Customer:

What can I do?

Dr. Shahzad MD :

You certainly are in a tough situation and you have to take a decision to discuss his problem with his doctor in detail and see what he thinks.

Dr. Shahzad MD :

I think that a reduction in the dose of medications or some other medications depending on a new diagnosis such as BPD may be something that may be required.

Customer:

Thank you, XXXXX XXXXX desoerate to resolve this , but obviously you cannot help

Customer:

I am so sorry to have disturbed your time. I fear for my family and cannot do anything more , I entered into counselling organised by my GP in Jan once a week and have found it invaluable, the children have been referred to pastoral care in school , all of these things are alien to our day to day life

Dr. Shahzad MD :

I understand I pray that he does get well soon.

Dr. Shahzad MD :

You are most welcome
Take care
Wish you all the best.
Please do rate me for my services before you leave by clicking on one of the smilies below. I hope I provided excellent services.
Good bye :)

Expert:  DrRussMD replied 2 years ago.
Hello

I am Doctor Thomas, double board certified doctor in internal medicine and integrative medicine. I will start by asking you a question or by giving you an answer based on your information provided so far. I will be here to follow up with any further questions or concerns you might have.


I would like to clear up some points here.

His psychiatrist is under no compulsion, and in fact is prohibited due to privacy unless he thinks it is critical to patient care, to discuss your husbands treatment or situation with you.

I have had patients in this situation before, as I am a clinician of over 20 years experience with patients.

Individual counseling is not going to be very productive in terms of resolving this.

First, lyrica does not have specific side effects reported as you state, but, it does have the side effect of "abnormal thinking"...and, not all side effects are known. Since this started after the lyrica, the lyrica needs to be stopped immediately. His reactions after starting this drug can be reported directly to the prescribing doctor, and the doctor is obligated to take this into account immediately.

Next....you need to find a Phd clinical psychologist trained in family therapy, and you both need to see that therapist, even if you start and invite him until he comes. Individual therapy might help you make decisions, but there is far more power in family therapy in many instances, and I have seen it succeed where other approaches fail. Re doing his meds and therapy are going to be needed here.

Use reply to let me know if you have further questions. [Click reply to expert].
Please do not forget a positive rating.

DrRussMD, Board Certified MD
Category: Medical
Satisfied Customers: 63850
Experience: Board certified Internal medicine and Integrative medicine. Many years of experience all areas.
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