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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by 10derheart on February 8, 2012, at 17:54:39
I have a close family member who has just been rx'd Saphris as his first tx for bipolar I. I am wondering what you all think of this. I am a bit surprised they would begin with an AAP.
He is a 30-year-old man who has been depressed with symptoms of apathy, lethargy, anhedonia, weight gain, excessive sleeping and eating, hopelessness, etc. for about one year. Before that he was acutely manic for weeks at a time, followed by brief (2-3 weeks tops) of depression and/or "normal" mood. In his manias he experienced much grandiose thinking, paranoia, irritability, overspending, some delusions and more things I've probably forgotten. The thing is, I thought maybe Saphris would be more for something acute, used first anyway. He has been formally diagnosed with bipolar by four providers: two MA social workers who are psychotherapists, one psychologist and the psychiatric nurse practitioner who is now prescribing.
Okay, so actually she rx'd Lamictal several weeks ago which he did not fill because he is 100% broke and the pharmacy needed $45.00. He knows I would have paid for at least the first month, but he did not/would not ask. So when time rolled around for the next appt., he emerges with this Saphris rx, supposedly because she needs to "stabilize his mood before prescribing anything for bipolar," and because it's "cheaper than the lamotrigine you can't afford." Yeah....huh?
I have to explain this perosn does not pay attention and his memory is also poor ever since this depression set in, so he is a bad reporter of anything that goes on in appointments. Not really his fault as I think the cognition stuff in part of the disease. So maybe it's not quite what she said. I get not giving one of the ADs alone, but I don't get that Saphris makes more sense than Lamictal. He has has zero manic symptoms since December 2010.
What does anyone think? What other info could I give here? We have prayed and waited for him to take a med - any med - because all his life he's been anti-med and refused and his manic episodes have caused great pain and turmoil in the family. But this drug seems so odd. She wants him on 5 mg 2x a day, but he is so severely exhausted and a little nauseated he is only taking 5mg once a day now. He says he can't stand these SEs for more than 2-3 more days.
I also worry as he has not seen a regular MD for over 10 years. He is about 30 pounds overweight and has never had his BP or BS tested, or anything else for that matter. I've been urging him to see a doc and have his testosterone checked for months and months now (he has almost zero interest in sex). Does anyone think think it's a little reckless to rx powerful meds without doing any baseline medical tests on a person? I do.
I know this is disjointed. I am in a hurry and anxious about a test I have to take today, so sorry for my less than flowing writing.
Thanks anyone....-- 10der
Posted by linkadge on February 8, 2012, at 18:05:28
In reply to All you wonderful experts on bipolar meds, posted by 10derheart on February 8, 2012, at 17:54:39
what about lithium. cheaper than anything. better track record too.
Linkadge
Posted by Phillipa on February 8, 2012, at 18:10:10
In reply to All you wonderful experts on bipolar meds, posted by 10derheart on February 8, 2012, at 17:54:39
10derHeart I agree with seeing a medical doc first. Is there a reason he won't see one? He to me sounds like my ex-father-in-law who had what at the time was called manic depression. Why not Lithium first? Not expensive either. Now the experts can take over on the lastest. Best thoughts to you both. Phillipa
Posted by 10derheart on February 8, 2012, at 19:04:10
In reply to Re: All you wonderful experts on bipolar meds, posted by linkadge on February 8, 2012, at 18:05:28
Hiya link,
Great question. I wondered, too, but he is so passive he won't ask, even when I write down questions for him. He figures she ought to know. Maybe the blood tests? Some other family members could probably **strongly** urge him to comply using scare tactics, but it would he hard. Not so fond of doctors.
What do you think of Saphris in his situation?
Lithium is generally cheap and generic, isn't it?
Posted by 10derheart on February 8, 2012, at 19:09:34
In reply to Re: All you wonderful experts on bipolar meds » 10derheart, posted by Phillipa on February 8, 2012, at 18:10:10
> 10derHeart I agree with seeing a medical doc first.
I knew you would :-) Common sense right?
>>Is there a reason he won't see one?
Yes. Too anxious to make a phone call to anyone he does not know. Only by lots of nagging (ok, more like threats he couldn't see his daughter alone or possibly at all if he didn't address the bipolar) was he "forced" to call a therapist who referred him to another MH clinic. He is unemployed and lives with other relatives. He gets care thru the state/medicaid and just can't bring himself to do another new thing he is so depressed and apathetic.>>He to me sounds like my ex-father-in-law who had what at the time was called manic depression.
Yes, he's in a long depressive stage, for sure.
>>Why not Lithium first? Not expensive either. Now the experts can take over on the lastest. Best thoughts to you both. Phillipa
Posted by linkadge on February 8, 2012, at 19:28:24
In reply to Re: All you wonderful experts on bipolar meds » linkadge, posted by 10derheart on February 8, 2012, at 19:04:10
>What do you think of Saphris in his situation?
>Lithium is generally cheap and generic, isn't it?
I remember a prescription of lithium cost me about $6 compared with seroquel (at the time) was about $250. I can't imagine saphris being that cheap.
Antipsychotics shouldn't be used as first line treatment (most psychiatrists are trained that). However, if the diagnosis is unclear (bipolar vs. schizohprenia) some psychiatrists like to be trendy.
I'd rather be on lithium personally.
Linkadge
Posted by 10derheart on February 8, 2012, at 20:35:44
In reply to Re: All you wonderful experts on bipolar meds, posted by linkadge on February 8, 2012, at 19:28:24
Yeah, Saphris likely isn't cheap at all, like I said he mixes up and/or forgets what people say a lot. I forgot she gave him some samples for now. Well, hope this doesn't come out wrong, but I'm sorta hoping it does not work or the SEs are intolerable. Maybe then we'll get back to something else. If not lithium, then Lamictal.
In the APRNs defense, she may be realistically assessing him as far as likelihood of compliance with any blood tests on lithium. He is a man with no car, no driver's license, no money, no job, no place of his own to live, and presently, no motivation or initiative to do or change a thing unless it comes from outside. He is anxious about many things and hates asking anyone to do anything for him even though at least three people are willing to, to an extent. It is difficult to deal with and balance compassion with the desire to kick *ss when a grown man will do virtually nothing to help himself. he would literally be homeless right now if someone very kind who really does not have room or the money to feed another person hadn't taken him in.
But that still doesn't explain the choice of Saphris, IMO. I can show him where to get lamotrigine online, perfectly leagl with a 'script, of course, for less than $15.00 a month. Bet if I check Saphris that won't be true.
Thanks for responding, link.
Sigh. I ****hate**** what MI is and does.
Posted by Phillipa on February 8, 2012, at 20:47:05
In reply to Re: All you wonderful experts on bipolar meds » linkadge, posted by 10derheart on February 8, 2012, at 20:35:44
l0der I picked up on the overweight and figured an AAP would add more and also make him more tired. He's sick he can't help himself. Anyway to get him admitted somewhere. There he will get a completed medical/physical, bloodwork done and a real pdoc. Not suicidal right? But he's kind of at harm to himself as he can't care for himself is that correct? If so 72 hour committment could do it. I once had a former babbler committed for the 72 hours. I knew where he lived the city and town googled the police there they sent out a team. Also they phoned me gave me his pdocs number called him and then I sent emails that showed harm to self could happen so his pdoc committed him. I'm proud to say that he no longer frequents here but is recovered now married with a child and his own business back. We email twice at least a day. So good things can come from bad things. Phillipa
Posted by Christ_empowered on February 9, 2012, at 0:15:16
In reply to Re: All you wonderful experts on bipolar meds » 10derheart, posted by Phillipa on February 8, 2012, at 20:47:05
Saphris? Ummm...yeah. Not only is it a neuroleptic for a mood disorder (not first line usually), its the newest thing around. And expensive. And, from what I've read, not that impressive.
I take Abilify for "Bipolar" (lots of psychosis, but..whatever. Better diagnosis than schizo-whatever). I get it off the net, no rx required (although I have one), for about 30ish monthly.
Posted by SLS on February 9, 2012, at 4:55:38
In reply to All you wonderful experts on bipolar meds, posted by 10derheart on February 8, 2012, at 17:54:39
Your description of your family member does sound like bipolar I rather than bipolar II. Lithium is considered the mood-stabilizer of choice in this illness. However, one can make an argument to use a AP now as an acute treatment for a severe mania. There are too many cases in which lithium takes over a week to exert antimanice effects. I would use both lithium and an AP and attempt to remove the AP after a short while.
I don't know why Saphris was chosen. I would ask the doctor what persuaded him to use it instead any of any of the others that are available. Maybe he and his colleagues are impressed with its clinical efficacy or side effect profile. Then again, the pharmaceutical company representative might have been overwhelmingly attractive.
I tried Saphris to treat bipolar depression. While it didn't help, it didn't hurt either. I did not experience any remarkable side effects. I just didn't like the sublingual delivery system.
- Scott
Posted by Beckett on February 9, 2012, at 5:39:19
In reply to Re: All you wonderful experts on bipolar meds » 10derheart, posted by SLS on February 9, 2012, at 4:55:38
Saphris does work fairly immediately and some studies show it has some good antidepressant qualities. My assumption is your relative's provider is awash in samples right now and should be able to keep him supplied. Personally, I preferred the sublingual delivery system, and Saphris regulated my sleep/wake cycle beautifully. It could be something he could take while persuaded to try lithium if that is a family and doctor consensus. Has anyone the opportunity to accompany him on an office visit as an advocate? Best of luck.
Posted by Raisinb on February 9, 2012, at 22:08:08
In reply to All you wonderful experts on bipolar meds, posted by 10derheart on February 8, 2012, at 17:54:39
What everyone else said: this doesn't sound right; when I was dosed BP, they put me on lithium right away. While it didn't ultimately work out, it is the first line treatment. If not lithium, depakote and tegretol/trileptal are commonly used.
Lamictal I think is considered good for controlling bipolar depression, but not mania. So if he gets manic, he'd likely need a different mood stabilizer.
I remember being on Lamictal a couple of years ago and for some reason it was mightily expensive--sixty bucks a month--due to my insurance formulary. I know it's generic, but that's what happened.
Posted by bleauberry on February 12, 2012, at 10:56:56
In reply to All you wonderful experts on bipolar meds, posted by 10derheart on February 8, 2012, at 17:54:39
Honestly, most or all of the routine lab tests done for depression patients will not show anything unusual. Not helpful in my opinion. The tests are good however to make sure there isn't something obviously wrong, such as a glucose spectrum thing or urine thing or whatever. If there is something unhealthy going on, we need to know about it, but it probably will not play any significant role in the depression treatment.
The tests are not going to show toxins in cells (petroleums, aluminum, cadmium, mercury, lead, plastics, herbicides, pesticides). They are not going to show occult stealth unsuspected chronic pathogenic infections of either viral, bacterial, or fungal origin. They are not going to give a good picture of what the immune system is doing or what the state of inflammation is. I mention these particular topics because in my opinion the vast majority of psych patients have one or more of these as the primary root cause of all their problems.
In my early days as a new psych patient I thought like everyone else that the doctors know what they are doing and that the drugs they say work actually work. Neither of those are reliably true. Despite our perception of having advanced medicine, what we know is far less than what we don't know.
Prescribing an AAP for what looks to someone to be bipolar is common. And often enough to keep trying it, they can be rapidly helpful. The problem I see is that most of us look at this approach as THE approach, the ONLY approach, and that somehow this one little pill is going to fix all the faulty biochemistries and damage? I think that approach is what keeps most of us sick. Illness is too complicated to approach that way, in my opinion. The AAP, as I see it, should be viewed simply as a temporary 'symptom manager', but the real work is other stuff.
Better mood stabilizers are available at Whole Foods Market or health food stores and include Rhodiola, Ashwaganda, Schizandra, and the cost is around $10; and some other supplements such as specific vitamins, minerals, and precursors.
But that's just my opinion for whatever it is worth. If the guy is really going to get better, it could happen with just an AAP but I seriously doubt it. We wish disease of the nervous system was that easy and straight forward.
Posted by phidippus on February 12, 2012, at 16:04:26
In reply to All you wonderful experts on bipolar meds, posted by 10derheart on February 8, 2012, at 17:54:39
He's got to want help.
Eric
This is the end of the thread.
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