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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by rho on January 17, 2009, at 12:19:42
My Bf ( a surgeon) believed for many years he suffered from unipolar depression. He self treated with high dose Prozac (up to 120 mg) plus PRN Valium for many years. for years ago he went off and went into a hypomanic state. He later saw a pscyhopharm who dx'd agitated depression and tx'd him with Welbutrin 300 mg alone. After again becomming hypomanic Lamictal was added and he was somewhat stabilized until last spring when he self prescribed Chantix to stop smoking. This thru him into acute Mania complete with affairs, promiscuity, irritablity, violence etc... He stopped the Chantix, saw a new pdoc who added lo dose prozac to control his psychomotor agitation. 6 months later and the Mania returned. I finally got him to a new psych to dx'd him as Mixed Mania, rapid cycling exacerbated by the Welbutrin. He is now slowly being tapered off the Welbutrin but still seems agitated and somewhat hypersexual (again on the internet looking for other women). Two weeks ago he broke off our 10 year relationship I think because he believes if I go away; so will his diagnosis. In the interim he is putting in well over 70 hour work weeks often operating all nite and now he wont have anything to do with me. Ive been in touch with his doctors (now 3) who say last week his affect changed and he became very dogmatic although 2 days ago he was tearful
What should I expect and
is he ever going to return to the wonderful loving partner he was or will he always blame me for this awful problem. Lastly why is insight such an issue and is there anything I can do to help him. he is stuggling so much I am afraid once he realizes what he has been doing he may get suicidal
Posted by Garnet71 on January 17, 2009, at 13:15:39
In reply to Welbutrin disaster, posted by rho on January 17, 2009, at 12:19:42
Hi rho,
You said you were dating him for 10 years. During any of this time, did you know him when he did not suffer from depression or bipolar?
I am concerned--if he is a surgeon, he could be a danger to patients in this manic state--a huge danger. Please think about that and consider intervening.
I've taking Wellbutrin several times. My family member with bipolar takes it-her pdoc said it is the best medication for bipolars because it doesn't stay in your system long. But yes, I can see how it could worsen mania. It is stimulating in general.
I'm sorry you are going through this. It's very clear you love and care about this person. I can't answer your questions, but others who are more educated or experienced may be able to offer suggestions or answers.
More questions--when you first started dating him, did you notice that he was very charming and charismatic? How does he feel about his illness? Does he ever blame anyone else for his actions? Just curious as there could be things beyond mental illness going on here, possibly, if you answer yes to any of those questions, and would want to rule that out first.
Best,
Garnet
Posted by Phillipa on January 17, 2009, at 13:25:36
In reply to Re: Welbutrin disaster » rho, posted by Garnet71 on January 17, 2009, at 13:15:39
I agree with above and I have no idea none at all just wanted to give you some support and know someone is hearing your pain. Love Phillipa
Posted by seldomseen on January 17, 2009, at 14:45:05
In reply to Welbutrin disaster, posted by rho on January 17, 2009, at 12:19:42
I think there are a lot of issues going on here, some of them drug related, some of them not.
From my own personal experience with prozac, 40 mgs of the drug induced tremors so bad that I could hardly hold a coffee cup. I can't imagine how a surgeon could deal with 120 - even with valium. :)
Seriously though, as a smoker who has quit before and suffered the consequences, I can not overestimate how crappy nicotine withdrawal is and how long it lasts. His entire brain chemistry changed when he put down that last cigarette and he may never be the person you knew before. I hope that he is still quit, but wowsa! it's a full on assault 24/7. Even if he starts smoking again things might be different.
Chantix is, IMO, not a safe drug and I'm glad he stopped.
As I'm sure you know, surgeons are IMO a rare breed of human. I'm not at all surprised to hear that a surgeon is manic. From my experience, various shades of bi-polar disorder are endemic in the surgical specialties.
Now add to that the fact that, physicians can be the hardest patients to treat, I doubt he will opt for some of the drugs that will most likely bring his mania under control (like seroquel, depakote, risperidol) because of the sedation they induce. Lamictal is a pretty good drug (IMO) and I hope that he is still on it.
Wellbutrin, with its activating properties, seems to be one of the favs with the medical profession because of it activating properties. But, well, you see the result when it is managed incorrectly.
As far as your relationship, 10 years is a long time to just walk away from, on both of your parts. However, whether in the relationship or not, his behaviour and his choices are ultimately his responsibility. There is only so much you can do. For whatever reason, it appears as though he's decided to go this alone.
I would most likely at this stage focus on myself, my grief and hope for the best from and for him.
Peace to you.
Seldom
Posted by diego on January 17, 2009, at 18:51:01
In reply to Re: Welbutrin disaster » rho, posted by seldomseen on January 17, 2009, at 14:45:05
Has lithium fallen so far out of favor it's not prescribed any longer?
Posted by Phillipa on January 17, 2009, at 20:01:54
In reply to Re: Welbutrin disaster, posted by diego on January 17, 2009, at 18:51:01
Diego think it's used quite a bit. Phillipa
Posted by SLS on January 17, 2009, at 20:34:49
In reply to Re: Welbutrin disaster, posted by diego on January 17, 2009, at 18:51:01
> Has lithium fallen so far out of favor it's not prescribed any longer?
It was the #1 adjunct to Parnate for quite some time.
Multiple toxicities with chronic use (kidneys and thyroid) and side effects have caused lithium to be a less popular first choice. However, for Bipolar I, there is generally no more reliable a treatment than lithium. It also can work with Lamictal to mitigate or prevent cycling. For bipolar disorder, dosages are generally within the range of 900-1500mg.
As an adjunct to antidepressants to treat depression, lithium is most often effective at low dosages (300-600mg). If it is going to work, it will produce a response most often within the first week. You get your answer pretty fast.
- Scott
Posted by desolationrower on January 18, 2009, at 6:09:26
In reply to Welbutrin disaster, posted by rho on January 17, 2009, at 12:19:42
> My Bf ( a surgeon) believed for many years he suffered from unipolar depression. He self treated with high dose Prozac (up to 120 mg) plus PRN Valium for many years. for years ago he went off and went into a hypomanic state. He later saw a pscyhopharm who dx'd agitated depression and tx'd him with Welbutrin 300 mg alone. After again becomming hypomanic Lamictal was added and he was somewhat stabilized until last spring when he self prescribed Chantix to stop smoking. This thru him into acute Mania complete with affairs, promiscuity, irritablity, violence etc... He stopped the Chantix, saw a new pdoc who added lo dose prozac to control his psychomotor agitation. 6 months later and the Mania returned. I finally got him to a new psych to dx'd him as Mixed Mania, rapid cycling exacerbated by the Welbutrin. He is now slowly being tapered off the Welbutrin but still seems agitated and somewhat hypersexual (again on the internet looking for other women). Two weeks ago he broke off our 10 year relationship I think because he believes if I go away; so will his diagnosis. In the interim he is putting in well over 70 hour work weeks often operating all nite and now he wont have anything to do with me. Ive been in touch with his doctors (now 3) who say last week his affect changed and he became very dogmatic although 2 days ago he was tearful
> What should I expect and
> is he ever going to return to the wonderful loving partner he was or will he always blame me for this awful problem. Lastly why is insight such an issue and is there anything I can do to help him. he is stuggling so much I am afraid once he realizes what he has been doing he may get suicidalWell i don't know what he's like, and for people with bipolar its harder than normal to know what your 'real' personality is...but i think you're right, he'll probably have problems with too much guilt once the mania ends...i'd say to help the main thing is getting mania controlled and not letting him hurt anyone at work...prozac is an odd choice to decrease agitation from mania...he really needs to be on a real mood stablizer, i don't know if he is refusing it, or the doctors don't think he needs one? sounds like a rough time for you, hope it works out
-d/r
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