[1278]

So I've been seeing my current pdoc for about a year and have seen no improvement, actually I've deteriorated during the course of my illness. So being frustrated I went and in for a second opinion without telling my current pdoc, but the new pdoc I went to (is a prof btw and 80+ years old) gave me a different set of medications and wants to see me again. The problem is I'm not sure what to do, to stay with my current pdoc or move to the new one. I'm so conflicted because they both seem to be confused about treating my specific type of bipolar(rapid cycling, mixed episodes) but the prof has obviously more experience but he is further away (about an hour an half and I don't drive) and my current psychiatrist has made concessions for me to see her and is half an hour away. I'm just so tired of being sick, in and out of hospital, of taking dozens of different medications, of waking up in morning and not knowing what my mood is going to be like. Plus my dad is putting so much pressure on me to get better, I'm putting pressure on me to get better, its like this cycle never ends.

[violetgreen]

Would your family doctor help you sort out the pros and cons of the 2 treatment plans? Would your current pdoc be open minded enough to look at the 2nd pdoc's plan and explain the pros, cons, and differences? With both of them seeming to be confused about how to treat you, I think you have to take charge somehow, and direct your doctors towards getting the care and results you need. It's like you have to be your own case manager, and the smartest person, making the best decisions for yourself. I know I've laid out more questions than suggestions, but you are in an unclear situation.

[pirilin]

Hi 1278,

Pdoc#1 treatment is not working.
Pdoc#2 new meds, but is farther away.
Distance should not be a factor is you improve.
Now, the meds part is where you need to be careful. What to fold and what to keep.
I'm in the same boat. Only my new Pdoc has been playing ball so far.
But I wonder if she really knows what she's doing.
The mental pacient telling the doctor what to prescribe, Hmm.
All The Best in your new adventure.

[Victoria'smom]

I'd try new pdoc for a little.

[Wanderlust90]

"Mixed episodes, rapid cycling," do we have our own little subgroup of bipolar or something. There are a few BP2s here that specifically deal with rapid & mixed cycles. I only point this out because I'm trying to find a med that others have found treats the dysphoric aspects of the illness, trileptal was one suggestion, APs also.

Can I ask what the new pdoc is thinking? & what meds he wants to try?

[1278]

Originally Posted by violetgreen

Would your family doctor help you sort out the pros and cons of the 2 treatment plans? Would your current pdoc be open minded enough to look at the 2nd pdoc's plan and explain the pros, cons, and differences? With both of them seeming to be confused about how to treat you, I think you have to take charge somehow, and direct your doctors towards getting the care and results you need. It's like you have to be your own case manager, and the smartest person, making the best decisions for yourself. I know I've laid out more questions than suggestions, but you are in an unclear situation.

Thank you for the questions, I think I have to take those into consideration though I'm just scared to mention to my first pdoc that I'm seeing another pdoc because I don't want her to get offended and stop seeing me. Its just a complicated situation, I guess.

[1278]

Originally Posted by pirilin

Hi 1278,

Pdoc#1 treatment is not working.
Pdoc#2 new meds, but is farther away.
Distance should not be a factor is you improve.
Now, the meds part is where you need to be careful. What to fold and what to keep.
I'm in the same boat. Only my new Pdoc has been playing ball so far.
But I wonder if she really knows what she's doing.
The mental pacient telling the doctor what to prescribe, Hmm.
All The Best in your new adventure.

Thank you pirilin, I found that once I was more vocal about what to prescribe, I did improve (I stopped taking SSRIs and now my suicidal ideation has improved)

[1278]

Originally Posted by Wanderlust90

"Mixed episodes, rapid cycling," do we have our own little subgroup of bipolar or something. There are a few BP2s here that specifically deal with rapid & mixed cycles. I only point this out because I'm trying to find a med that others have found treats the dysphoric aspects of the illness, trileptal was one suggestion, APs also.

Can I ask what the new pdoc is thinking? & what meds he wants to try?

He wanted to try meds and APs I'd been or currently been on. Geodon, abilify, risperdal, seroquel, lamictal, topamax, SSRIs because I am mainly depressive part of the spectrum. I've been on 10-15 different medications already. I've also had ECT. I've been in hospital 6 times in 2 years.The only reason I mentioned the rapid cycling and mixed episodes is because I was on antidepressants for 2 years before any doctors thought "hey, we could be making the situation worse, antidepressants cause rapid cycling" I'm so F***** fed up of all these doctors bull****. But how do I survive without medication???? Can someone tell me how?

[1278]

Sorry for the rant, I'm just really frustrated, angry, depressed, and tired. So yeah, the new pdoc hasn't brought anything new to the table so far, trileptal was mentioned but because I brought it up thanks to people who mentioned it here on the forums. I can't take latuda and saphris because its not available in my country yet (I asked)

[Icare dixit]

I've always dealt with a lot of dense/mixed cycling between longer mania, post-mania/severe and mild episodes of depression. Pretty much continuous cycling.

I wouldn't suggest antidepressants. Atypical antipsychotics will do what e.g. SSRIs do and they counterbalance some of negative effects they can induce. They go beyond that to be antipsychotic, which in the context of mood can be like weathering the storm with an oil tanker instead of a canoe: longer cycles and more moderate.

For monotherapy I would suggest aripiprazole (Abilify or generics), because it is a bit more "activating" than e.g. olanzapine or quetiapine.

But I wouldn't suggest monotherapy. Since depression is your main problem I would without hesitation suggest lamotrigine as mood stabiliser, to calm the storm itself. It is like taking your oil tanker out on the ocean instead of the sea: you might go up, but not equally far down (I don't know whether this analogy has any footing in reality, but I like to think that that's something that separates oceans from seas).

The antipsychotic should therefore counterbalance that a bit (having two meds working against each other is always good: just tune your doses). I would therefore not use aripiprazole, but something like olanzapine or quetiapine.

I hope this might help. I am no doctor so that should help.

A professor is not per se more experienced than a clinician, age difference or not, most likely not if his research area is not BP or includes BP, or he doesn't himself have a psychotic disorder (always nice to have) very much like BP or BP. Some scientists know very much about other fields and/or are also very much involved in clinical work, others not so much.

Personally I would go for the professor but I may be very much biased. As already mentioned, just let your current psychiatrist know about the second opinion and ask whether one contacts the other. For you the clinician may be more interesting. You also just have to relate as human beings.

Go for the one that tries to understand you, but also doesn't hold back.

Hope it all works out fine.