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Q: Would Additional Therapy Help or an Increase in Meds?
Diagnosed with being bipolar 25 years ago and up till
recently have thought I maintained myself fairly well. Having been through lots
of stress at home & work my doctor changed my medication dosage slightly and yet
I am having lots of trouble concentrating, sleeping, anxiety, & a few other
issues. Would additional therapy help with this, or an increase in medication
(take depakote & paxil twice a day) or do you have another suggestion. Thank
you very much for your time.
Beth
Dear Beth
Bottom line: without knowing a whole bunch of other details about
your situation, I can't tell you what kind of treatment approach to take. But I
will give you a recent research result, and a speculation to discuss with your
psychiatrist.
An important, relatively little-known research study
(unfortunate, because it is a major advance in the field) showed that
psychotherapy was an effective treatment for bipolar depressionMiklowitz
other less direct evidence suggests that psychotherapy can be
effective for anxiety and a variety of conditions (even though we don't have
direct evidence for anxiety in a bipolar context). So you are right,
psychotherapy is an important alternative to consider.
Here's the speculation: I am guessing that the medication dosage
adjustment was an increase in Paxil (paroxetine). If that is true, then you have
to wonder whether Paxil itself might be at least a part of the basis for these
new symptoms you describe. That might be possible. The mechanism would be
this: antidepressants are known to increase manic symptoms in some people. The
three symptoms you describe -- trouble with sleep, anxiety, and concentration --
can all be part of a (probably very mild, at this point) increase in manic
symptoms.
Obviously this is worth considering as it suggests that one way
to cope with these symptoms is to return the dose of Paxil to its previous
level, and find some other means of addressing the targets which were the basis
of the dose shift in the first place. However, may I emphasize as firmly as
possible: do not make a dose change on your own without discussing it with your
physician. Even if this speculation is correct, at could end up creating yet
more symptoms and "chasing your tail". More importantly, this entire line of
reasoning could be completely in error and you could be going in the wrong
direction.
Good luck to you and your doctor can figuring this all out.
Dr. Phelps
Published May, 2008
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