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    Dr. - My 20 year old son was recently diagnosed with bipolar 1. Finding the right Dr. and right med. is a challenge.
    lovingmomwithbipolarson posted:
    The Dr. my son is taking Seroquel XR 450 alone. He has been dpressed for two months. I can't stand seeing him like this anymore. The Dr. is against using antidepressants because it can send him into mania. But in the mean time his depression got so bad he started having racing and suicidal thoughts and was increased from 450 to 600. Is Seroquel a mood stabilizer and an antidepressant.

    He was on risperdone in Jan. when his episode first started, he wasn't so miserable and wanted to go out and do things. We changed from Risperdone because of side affects. He couldn't move and when he did we thought he was going to fall over, he was pale, and had no energy. He was so stiff he didn't move his arms when he walked.

    How can I find a list of Dr.'s who specialize in Bipolar including a therapist. I don't want to take him to a therapist who specializes in marriage counciling.
    bentandbroken responded:
    The Seroquel is only a mood stabilizer. Docs usually like to introduce one drug at a time.Get his mood stabilized then add an anti-d slowly so he doesnt go onto mania.I take Seroquel to 600mg of the regular not the xr.I was on it for a month or so before I got on Cymbalta as my anti-d.My pdoc works at the hospital I was in,so he knows a thing or two about unstable people. Maybe look into a doc from a psych ward to help your son.Also,good luck finding a good therapist,it seems they all claim to specialize in bipolar and cognitive behavior therapy.Keep trying until you find one he can relate to and do him some good. Most of all be villigant in getting him good help.He probably needs your help in advocating for him.I have two kids with bipolar, my daughter is 16 and my son is 25 but unmedicated,he can really be a challenge.So can she but at least she has meds to slow her responces.This board can be a plethera of info for you and him.youll find the people here to be very informative and supportive.Please make this board a new source of info for him.Good luck,and keep us posted .............
    lovingmomwithbipolarson replied to bentandbroken's response:
    Thank you bentandbroken. The other thing that bothers me is the fact that he seems so miserable. When he was taking the Riserpidone he wanted to do things like go to the gym and to work with my husband. With the Seroquel he seems miserable and doesn't leave his room. I don't know if it's the bipolar or the medications or just not the right meds yet.
    Joseph F Goldberg, MD responded:
    Dear Lovingmom,

    Seroquel is approved by the FDA as an antidepressant for bipolar disorder. Only it and the drug Symbyax are FDA-approved for bipolar depression. (The term "mood stabilizer" is actually not a real term the FDA uses...drugs don't get "approved" as mood stabilizers, it's a term that somewhere crept into popular culture but has no medical meaning).

    If 600 mg/day of Seroquel is not producing an antidepressant result (the maximum dose studied for bipolar depression), Symbyax might be a worthwhile FDA-approved alternative. Some doctors also are sufficiently impressed with the antidepressant data with Lamictal to add it in for that purpose. Have a look at the video link I posted under Resources some time ago which discusses the treatments for bipolar depression, including the pros and cons of antidepressants.

    In terms of finding bipolar specialists, you might check the link I also posted under Resources for members of the American Society for Clinical Psychopharmacology.

    Good luck.

    - Dr. G,
    Joseph F Goldberg, MD replied to bentandbroken's response:
    Of note, nobody has ever studied Cymbalta to treat depression in bipolar disorder, so technically, it is an experimental treatment for that use. By contrast, Seroquel is FDA-approved as an antidepressant for bipolar depression. Seroquel treats either mania or bipolar depression better than a placebo.

    - Dr. G.
    lovingmomwithbipolarson replied to Joseph F Goldberg, MD's response:
    Dr. Goldberg, My son was just increased on Mon. to 600, how long should it take to see the full effect of the increase? Does Seroquel treat BP 1 without additional meds? I read the following in one of you replies:

    If your son has bipolar disorder, one issue would be whether he has received the appropriate treatments for it -- lithium, Depakote and Tegretol remain the fundamental treatments for bipolar illness, and if he has not been on any of these, he may be experiencing the consequences of having never had the proper treatment.

    Well my son has never received any of the above. I like the idea of adding lamictal. It seems to have good reviews by people using it. I noticed a few take it with Seroquel.

    Thank you.
    Joseph F Goldberg, MD replied to lovingmomwithbipolarson's response:
    Dear Lovingmom,

    Studies have shown that antidepressant effects with Seroquel are usually evident within 1-4 weeks after reaching a dose of 300 mg/day. Higher doses are often used to treat mania symptoms if they too are present. Lamictal often can be a very appropriate augmentation treatment to Seroquel for bipolar depression. Lithium, Depakote and Tegretol all are more effective at treating or preventing mania than depression...but if mania is present, these 3 are the medicines that have been around the longest. Seroquel by itself if FDA-approved to treat mania and represents a reasonable alternative to these more "classical" medicines.

    - Dr. G.
    lovingmomwithbipolarson replied to Joseph F Goldberg, MD's response:
    Dr. my son has been on Seroquel 600 mg since Mon. I see a little improvement but he's still depressed, having suicital thoughts and delusions. After the risperdone we did try abilify in March for 2 weeks, his legs were constanly moving and with no antidepressant he became very depressed - but didn't experience delusions. The two times he became depressed on the seroquel once in March on 300 mg and just recently on 450 he had the psychosis. You are about 1 hour and 45 min. from me, are you taking new patients? I really just want to get it right so my son can feel better. He is so miserable and not so nice. He's not himself.
    lovingmomwithbipolarson replied to lovingmomwithbipolarson's response:
    Dr. G

    I spoke to my sons Dr. today to let her know he still wasn't better she told me it's going to take some time. I do see an improvement over yesterday. I do plan on getting him into a drug treatment program and therapy as soon as he is stable enough. Being that he did smoke cannibis how long do you think it should take for the Seroquel to take full affect again? Is it like starting over? He started Seroquel in March at 300 then to 450 now 600. HIs Dr. tells me that Seroquel is approved for maintenance for bipolar but I'm not liking the antipsychotic meds at all. I don't know if its the illness or the Seroquel but he hasn't been himself, maybe it's the depressed mood. When he was taking risperdone he wanted to go out and do things. Maybe he was manic or mania then - but atleast he seem like he wanted to do things. How can I tell if it's the mood or the medication?

    Thank you Dr. G for all your answers.
    Joseph F Goldberg, MD replied to lovingmomwithbipolarson's response:
    "Maintenance" comes after resolution of an episode. Seroquel is approved for both acute episodes of either mania or depression or maintenance, but it sounds as though he is still acutely ill. Cannabis doesn't help the picture but in itself is unlikely to cause mania or depression, so much as diminish the effect of a medication -- and, studies have shown that even a past history of drug abuse can diminish the responsiveness to any mood stabilizing, the longer he is abstinent, the better. If someone is still depressed and having suicidal thoughts on 600 mg/day of Seroquel after more than 2 weeks I would probably be inclined to try something else, like Symbiax. Affirm with his doctor that nobody thinks he would be better served in the hospital. If so, and if after 2 weeks there is still no improvement, let the doctor know you'd like a 2nd opinion if the doctor isn't prepared to make a change.

    - Dr. G.
    lovingmomwithbipolarson replied to Joseph F Goldberg, MD's response:
    I have already made an appointment with another Dr. for a second opinion. May 13 was the first appt. I could get. He was recommended to me by a woman who has two children with bipolar and they seem to be doing very well. I live in Staten Island and my sons Dr. is in the city. The Dr. I have the appt. with on the 13 is on Staten Island so I think it will be easier for my son to see him once a week for as long as needed. His current Dr. doesn't seem to want to add anything. I keep asking her. She only wants to increase the Seroquel. The trip to the city is taking a toll on all of us.

    Hopefully I will have luck with the local Dr. if she doesn't add anything if needed before then.

    He's been on the 600 mg for 8 days now so I will give it till Mon.

    I wish you were closer. If I don't have any luck by the end of next week, I may be calling you for an appointment.

    Thanks for all your help.
    lovingmomwithbipolarson replied to Joseph F Goldberg, MD's response:
    Dr. G.

    Is 600 enough to treat the delusions as well as the depression? He does seem a little better today. He took a shower and got dressed and had something to eat. He keeps having this one thought though, he thinks he has money coming to him and keeps asking for it. How long does an episode last?
    Joseph F Goldberg, MD replied to lovingmomwithbipolarson's response:
    600-800 mg/day is an average anti-psychotic dose of Seroquel, and some practitioners advocate even higher doses for psychosis, beyond the manufacturer's recommendations, up to 1600 mg/day or so. More sedation at higher and higher doses though.

    - Dr. G.
    brigitte29 responded:
    Hi lovingmomwithbipolarson, I just found out my 22 year old son has bipolar with sever psychosis right now. We were thinking it was from smoking marijuana in China but that has been over 3 weeks ago and they've diagnosed him with bipolar and he's had several manic episodes. He's not on Seroquel. I just wanted to get feedback since your experience was 3 years ago about how it's going. This is all so new and foreign to me. Please reply if you have time.
    Chris_WebMD_Staff replied to brigitte29's response:
    Welcome Brigitte29,

    If you would like additional support and to ask more questions, please click on the "post now" orange button at the top of this page. Click on discussion and that will let you post a new question or topic.

    I hope that helps, I'm glad you found us. Best of luck and health to your son.

    Life is too short, so kiss slowly, laugh insanely, love truly and forgive quickly.
    Author Unknown

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