April 26, 2007

"Inflammable Means Flammable? What A Country!"

You're going to say that I made this up.  I am not making this up.  I wish I was, because then I could say,"stop making things up," and everything would be ok.  But it really happened, and I can't stop things from really happening.  So I drink.

This is the conversation I had with another psychiatrist.  He is wearing a Ermenegildo Zegna suit.  It fits him well.

I say, "... so if I have him [hypothetical bipolar depressed patient] on Depakote and Seroquel, once he's stable I try to reduce the dose, or even stop one of the medications."

He shakes his head. "I would never stop the mood stabilizer."

"Why-- wait, which one's the mood stabilizer?"

"The Depakote."

"But how do you know it wasn't the Seroquel?  That's the problem with starting two drugs immediately, you don't know which one worked."

"Well, you need them both.  Especially if you're adding an antidepressant."

"What antidepressant?"


"Seroquel's an antidepressant?"

"In this case it is, you're using it for bipolar depression."

I blink my eyes, to make sure I still can.

"Then what's the Depakote?" 

"The Depakote is the mood stabilizer."

"But how do you know the mood stabilizer isn't the Seroquel?"

"The Seroquel is the antipsychotic."

A voice tells me to stab him.

"Why can't you just use the Seroquel-- the antipsychotic- slash- antidepressant-- alone as a first try?  What benefit does the Depakote give you over the Seroquel?"

He says it slowly, enunciates, because he deduces that I don't speak English.  "Because the Depakote is the mood stabilizer..." 

He looks at me. I look at him. He is wearing a yellow Bolgheri tie.  In my mind it is on fire.

"...Besides, if you use Seroquel off label like that, you'll get sued."  Blaming lawyers, the last refuge of the incompetent.  "And for what?  Why take the risk?"

It's at this point I realize he's not wearing socks.  "If you're going to use that logic, Depakote isn't indicated for mood stabilization, either." 

He looks at me incredulously, then suddenly he realizes something.  "Oh, okay, right, I see what you're saying now... but at least Depakote has FDA approval for Bipolar Disorder."  QED.  He's very happy now.   I can't find the waiter.  Why is my drink empty?

There's an uncomfortable pause.  He wants to show me he's a skeptic, too, that he's carefully pondered these issues.

"I have a theory, have you ever used meclizine (a drug for vertigo) as a mood stabilizer?" 

"No, I had never heard of that."

"I haven't tried it either, but it might make sense: meclizine stabilizes your balance, so perhaps it could stabilize your moods?"

I want to call the State Board of Medicine but realize I'm in a different state and I don't have the number in my phone.  "I doubt the insurance companies would ever cover it."

He slowly, purposefully, nods his head.  "Fucking meddling managed care."


I tell people all the time, don't get sick, don't ever get sick, but no one listens to me. 



Well, at least he has a goo... (Below threshold)

April 29, 2007 11:36 AM | Posted by Nick: | Reply

Well, at least he has a good tailor. (I'm trying for the glass is half full approach?)

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Horrifying. Surely he's an ... (Below threshold)

April 29, 2007 11:57 AM | Posted by seamonkey: | Reply

Horrifying. Surely he's an aberration? Tell me that's not typical!

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Sounds like something out o... (Below threshold)

April 30, 2007 1:59 AM | Posted by Dr DJ: | Reply

Sounds like something out of Mount Misery!

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I've had this same conversa... (Below threshold)

May 1, 2007 4:58 AM | Posted by anon: | Reply

I've had this same conversation with my psych. I give him credit when he admits to being in the same game of russian roulette of medicating patients. "Depakote just works, we just don't know why"

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Aside from stabilizing mood... (Below threshold)

May 5, 2007 2:38 PM | Posted by Gab: | Reply

Aside from stabilizing mood, there's evidence that anticonvulsants protect the brain from migraine and minor seizures, both of which are believed to be co-morbid with bipolar. So in addition to stabilizing mood, Depakote may ameliorate certain neurological insults. Having said that, Lamictal would be a better choice. The patient is much more likely to be compliant with Lamictal because of the lack of side effects. Especially for female patients, caution should be taken when prescribing Depakote as it exacerbates some hormonal conditions, such as polycystic ovarian syndrome. Because lamictal needs to be titrated very slowly, you may choose to start with something along the lines of trileptal, along with a healthy dose of seroquel. The recent news of the inefficacy of antidepressants in the treatment of bipolar should further encourage the use of anticonvulsants and atypical antipsychotics.

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This is one of my favorite ... (Below threshold)

July 1, 2008 2:03 PM | Posted by Brad: | Reply

This is one of my favorite posts. Lastie, I'll bet you a bottle of rum I can guess your favorite novel.

Alone's response: I'd take that bet, because you'd be wrong. And I want that rum.

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Necromancy, I know, but I c... (Below threshold)

November 1, 2011 10:29 AM | Posted by Nepeta: | Reply

Necromancy, I know, but I couldn't let this go...

""The Seroquel is the antipsychotic."

A voice tells me to stab him."


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re: favorite book....hitchh... (Below threshold)

April 4, 2014 7:52 AM | Posted by Anonymous: | Reply

re: favorite book....hitchhiker's guide?

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Would this guy be... a ... (Below threshold)

February 16, 2015 1:56 PM | Posted by Mircea Popescu: | Reply

Would this guy be... a typical anti-psychotic, then ? After all... he fights psychosis, right ?

Or is he more like a mood stabilizer ?

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