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Dr. G - Questions regarding anti-psychotics
mercygive posted:
Dear Dr. G,

I am taking the following medicines: Levothyroxine .137 mg for treatment of hypothyroidism; Lamictal 300 mg; and, Seroquel 300 mg for treatment of depression, mania and most importantly psychosis. I understand from my reading here that I should expect the Seroquel dosage to increase to 400 mg to treat mania, and over 400 mg to treat psychosis so long as I can tolerate the sedation with each dosage increase. I understand that Seroquel or any anti-psychotic should not be prescribed for long-term use.

My psychiatrist recommends that I use on Seroquel (or Risperdal) daily for the rest of my life to treat and/or prevent recurring psychosis. What I have read here contradicts my psychiatrist's recommendation to use anti-psychotics long term.

How long should a doctor recommend that I use an anti-psychotic for recurring psychosis? Do all patients who take anti-psychotics, eventually over the course of their treatment, experience some or all of the side effects? What are the medications that are used to treat the side-effects? Is it better to continue to take an anti-psychotic (for psychosis) and take medicines to treat the side effects, or discontinue the anti-psychotic altogether when side effects occur? Are there any other medicines that treat or prevent psychosis?

Also, I read that psychiatrists overly use the Lamictal/Seroquel combination in older bipolar patients because they are more prone to aging health concerns. In your practice, what medicines do you prescribe for older bipolar patients, specifically, patients who have never been treated with Lithium or Depakote?

Thank you so much!

Joseph F Goldberg, MD responded:
Dear mercygive,

There is no "time limit" on how long an antipsychotic can be prescribed. Seroquel is FDA-approved for long-term maintenance treatment, which is to say, indefinite use, so long as the prescriber is monitoring the need for ongoing treatment, and potential side effects (ie, weight gain, changes in blood sugar or cholesterol, abnormal motor movements).

Seroquel plus Lamictal is a combination that has never formally been studied in bipolar depression but inasmuch as both can help bipolar depression, and neither causes mania, it is a reasonable combination.

Any and all medicines that are customarily used for bipolar disorder can be prescribed in older adults provided that one is watchful for side effects and sometimes lower dosing. There are no particularly unique medicines to use.

Dr. G.
monkeybee replied to Joseph F Goldberg, MD's response:

I'm right there with you. I will be on an antipsychotic long term too. I've been worried about the side effects also!

That's a comforting answer, Dr. G!

mercygive replied to monkeybee's response:
Dr. G. I misread. Thank you for the explanation.
A little yoga goes a along way
mercygive replied to monkeybee's response:
Hi Sarah,

Thanks for being there. I don't know about you, but it's not an easy subject to talk about with my husband. I am hopeful that our open discussions will support the success of my treatment.

It's wonderful to have you on the board.

A little yoga goes a along way
monkeybee replied to mercygive's response:
Thank you very much, Mercy! It is very hard to talk about with my husband sometimes, especially when I'm not sure if I'm well or not. He loves and tries, but he just doesn't understand. You and this wonderful group understands. I would love to help or listen whenever you need it! Its scary and lonely to fight this illness, but its especially scary to lose touch. I think the meds are far better than psychosis!


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Joseph F. Goldberg, MD, is a Clinical Professor of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY. He also maintains a private prac...More

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