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Drugs make my bipolar mom a shell of herself. She says it's worth it.
December 26, 2012 6:33 AM   Subscribe

Extremely medicated mom: My mom has struggled with intense bipolar disorder for most of her life. She attempted suicide twice and has been hospitalized 3 times. For the past 3 years or so, medication has stabilized her moods, but at what appears to me to be a heavy cost. She's dulled and flattened to the point that she seems like only a small fraction of the person she was. It's hard for me to see her this way, but I don't know what I can do.

She used to be a smart, fiery, energetic woman (when not in her depressive phase). In her current (medicated) state, it's as if she's running at 1/5 speed. She has no facial expressions. She shuffles very slowly around the house. It takes her 10 seconds to bring a fork from a plate to her mouth. She stares off into space most of the time and there's a good 3 second delay before she acknowledges in any way that you've said something to her. She speaks in a slow, weak monotone and rarely follows the thread of a conversation thread than a few exchanges. She has no interest in anything but also expresses no boredom. It feels to me like she's gone.

She lives in a rural town with my dad and sees a psychiatrist in a city 90 miles away every few months. I live across the country and come home to visit a few times a year. When I ask my dad how he feels about her condition, he says he sees it as making the best of a bad situation... at least she's not so miserable she wants to die. When I ask my mom how she feels, she says "I feel good... much better..." (while her expressionless face stares off into space). I think that from their perspective, they feel like they've reached a small shelter in a long and terrible storm. They're not interested in adjusting medication any farther. According to them, the psychiatrist is satisfied with leaving things as they are.

I don't know what to do. Do I press them? How much? Purely selfishly, I want some semblance of my mom back. If it were me, I think that I wouldn't want someone to just let me live out my life in a haze. Yet I know how much she (and in a different sense, my dad) has suffered because of the bipolar and she's telling me that all things considered, she feels better than before. What if the alternative really is jumping back into the fire that made her try to end her life twice? Yet still, I can't help but feel that the person I knew as mom is no longer with me just the same.

Any suggestions or experiences to pass along are welcome.

FWIW, each day she takes 12mg of Xanax (Internet suggests that's very high), Abilify, and Wellbutrin.

Added difficulty: She may soon need heart surgery for a problem with a valve. Yeah.
posted by anonymous to Health & Fitness (20 answers total) 5 users marked this as a favorite
 
No one here can speak specifically to her medications, although there will likely be folks who will do so anyway. We simply don't have enough information.

From the small amount that you've described here, she does sound over medicated, and you are correct that she's on quite a lot of Xanax, which is not normally a first line agent for treating bipolar disorder.

However, we have no way of knowing what's appropriate for her, what was tried before, what dosages were ineffective, what your mom actually presents like (beyond your brief description here). Were I in your situation I would try to have a conversation with my father about mom seeming over medicated, and I would ask to get a signed release in order to speak with the psychiatrist about it as well. You may not have all the available information, the doctor may not see enough of your mother to sense that she is over medicated (if she is). I would present the conversation as a concern about the empirical things you have listed here, and I would by no means use the phrase "over medicated" with the psychiatrist.

Good luck.
posted by OmieWise at 6:57 AM on December 26, 2012 [3 favorites]


Honestly? I know this is hard, but if your mom is happy with this you should be too. This is not your choice to make.

Purely selfishly, I want some semblance of my mom back.

What if the alternative to the meds is that she follows through on the suicidal tendencies?
posted by Brittanie at 6:58 AM on December 26, 2012 [9 favorites]


While I am sure there are benefits to your mother, your father and the medical professionals they work with taking a close look at her medications, I don't think it should be a concern of yours.

The mother you grew up with was very sick. Yet you loved her. In a way, you loved her sickness too. You may want to consider how to allow yourself to "suffer" the loss of your mothers sickness. The painful (to you) loss of your mothers illness is what has, by her own admission, brought her a better life.

Let the sickness (which you experienced as "mom") go. Learn to love the mom you've got today.
posted by waterisfinite at 7:05 AM on December 26, 2012 [10 favorites]


Is there any way you can accompany her to an appointment to be her advocate? My mom has bipolar disorder, and she has been stable and functioning for the last 26 years when she is medicated (lithium and risperdal here). I am definitely not a doctor, but Wellbutrin can be contraindicated for bipolar due to triggering mania. Is it possible to get a second opinion?

I would try to go with your mom to a second opinion, have the psychiatrist observe her sluggishness, calmly list your concerns and ask about their opinion of her medication and the pros and cons of other medication options. For example, Lithium requires blood tests every couple months to make sure the limit is appropriate, which could be burdensome with doctors so far away. It would also be great info to have other drugs or combos your mom has tried.

I'm sorry you and your family are going through this. It is rare to find psych drugs and combos that work well on the first try, and a lot of it is still trial, monitor, and adjust.
posted by shortyJBot at 7:07 AM on December 26, 2012


Unless you're willing to get more involved on a day-to-day basis, which your geography suggests will be difficult if not impossible. . . there may not be a whole lot for you to do here. Your mother, your father (her husband) and her physicians are managing this condition. They get a say in how this happens. You, as a daughter, might possibly get a seat at that table, but only if you're willing to sit in it. Visiting a few times a year probably doesn't count.

Another point. Under other circumstances I'd recommend getting a second opinion. A pair of fresh eyes might help. This isn't to say anything bad about your mother's psychiatrist. This may be his standard practice, or he may just know enough about the situation that he doesn't think changing things is worth the risk of increased suicidal ideation. Regardless, any time the outcome seems less than idea, getting a second opinion is a good idea. Physicians don't take it poorly when patients ask for one, and most make it a regular practice of consulting with their colleagues on difficult cases.

But there may not be any. What you're describing is actually a fairly common problem in the rural areas of the country. Most rural areas are technically served by all of the relevant specialties, but "served" in this case generally means "accepting patients from that region if they're willing to drive two hours each way." This means that unless they're willing to drive even farther than that, there may not be a second opinion available. In major and even minor urban areas there are frequently multiple specialists in every specialty, and if you don't like this one, that one down the road will be happy to take your business. But in more rural areas, particularly west of the Mississippi you don't tend to have that luxury. The nearest hospital can be two hours away, and the next nearest one might be four or six. Your parents may thus be doing most of what it's in their power to do.

And this doesn't just restrict your parents' access to second opinions. It may also restrict what options are available, period. It may be that changing your mother's medication would require more frequent appointments, and that may not be something your parents are willing or able to do. Even for minor medication adjustments, psychiatrists frequently schedule weekly appointments for at least a little while, to make sure that everything is going okay and giving them the chance to make adjustments quickly. We're talking about a person who has attempted suicide twice. I know I wouldn't be excited about altering what appears to be an at least stable medication regime unless I was able to meet with her more regularly than a few times a year.
posted by valkyryn at 7:26 AM on December 26, 2012 [3 favorites]


Press them. I have never understood the contingent on here that says your own mom's none of your business. There's got to be a better psychiatrist.
posted by steinsaltz at 8:01 AM on December 26, 2012 [2 favorites]


It sounds like they're both exhausted. Things can take longer and more effort all around when you live out in the country, so it may be that they just can't do more. What might help them more than telling them what additional things they should be doing is somehow making their lives easier. I don't know how you can do that, but it's my one idea.

This sounds really difficult -- I can't imagine how you must be feeling. Best wishes to you.
posted by amtho at 8:05 AM on December 26, 2012 [1 favorite]


I disagree with those that say the current condition may be better than how she used to be. If she was fiery and energetic (when not in a manic state), medication shouldn't blunt her affect to the point that it takes 10 seconds for her utensils to reach her mouth. I'd press your father on this and get more involved with her medical care. It's hard to go on and off meds in order to get them right, but you're right, being in a zombie-like state is too high a price to pay. Your parents are doing their best but maybe they need some more support. Any other sibs or family members in the picture?

Perhaps someone with bipolar disorder will chime in on their experiences... Good luck!
posted by Sal and Richard at 8:48 AM on December 26, 2012


I know I will get flack for this, but while I am not a doctor I do work in a psych hospital. She sounds way too sedated, and I would be asking why she's not on Lithium. She may not have been able to tolerate it and that's OK, but they really need a good reason for ruling it out. What is she like in the morning before she takes her Xanax? She can't be taking 12 mg all at once...surely that's spread out over the course of the day. It could be that she could back down of the Xanax just a tad and still be functional (DO NOT DO THIS WITHOUT A DOCTORS APPROVAL!).

Honestly, if she's not willing to do anything there's not much you can do as well. At the very least, you could have a conversation with them about what meds have been tried and why they didn't work. That might give you a better overall picture of the situation.
posted by MultiFaceted at 8:50 AM on December 26, 2012


I think that from their perspective, they feel like they've reached a small shelter in a long and terrible storm. They're not interested in adjusting medication any farther. According to them, the psychiatrist is satisfied with leaving things as they are.

This is the real issue. The psychiatrist, whatever his professional tendencies, is taking treatment cues from your parents. Your parents are satisfied with the status quo. To be an advocate you don't need a second opinion (they probably won't listen) or to browbeat the psychiatrist yourself (again, the patient and her spouse will have more weight) -- you need to work with your parents to determine what and how much they want to improve things.
posted by dhartung at 9:55 AM on December 26, 2012


In your shoes, I'd at least voice my concerns clearly, present all the options, and then let it drop if your parents are happy with the way things are. I would bring up the worrisome symptoms, suggest that with a second opinion a better treatment plan, and then listen to what they say. It's very possible that your parents are exhausted from decades of illness, and if it took 100 medicine combinations to get anything that works at all, it might seem unlikely to them that the 101st combination will make things better and not worse. Alternatively, it could be the 90 mile journey that makes getting a second opinion all but impossible. In this case, what are you willing to offer? Could you move home for a period and be responsible for your mother's care? Are your parents interested in moving near you?
posted by fermezporte at 10:57 AM on December 26, 2012 [1 favorite]


N-thing that you should try to accompany her to an appointment, express your concerns, and try to get more insight into why her treatment ended up what it is. I know my doctor much appreciates the visits when I bring a family member. My family member asks tons of questions and irritates the hell out of me -- which is great, because it lets the doctor observe our dynamic and lets me know how much the family member cares. Heh.

re: "why isn't she taking lithium (or another mood stabilizer)?" Abilify alone is approved for maintenance treatment, although the research isn't great: http://thoughtbroadcast.com/2011/05/31/abilify-for-bipolar-maintenance-more-hard-questions/
posted by sock puppet du jour at 11:45 AM on December 26, 2012


I came running in here to say that as the partner of a bipolar person, I feel (and he agrees when he's not manic) that medicated is better than not, and some not-great side effects may be a better trade-off than the hell of endless med tweaking that is the alternative.

But then I read the rest of your post and with side effects that bad, I would have some of the questions and concerns you have. I think you are absolutely right to be checking in with both parents on how things are going and what the psychiatrist says, and to maybe keep checking in periodically.

But part of this is all you - even with the best balance of meds in the world, your mom is never going to be the person you remember her being, and doesn't want to be that person because that person was in a world of pain even if she hid it well. That's something you need to deal with yourself, and it's hard, and you probably need some support. A therapist, a bipolar family group, a friend - someone to help you sort through this. It's hard and it's ongoing and I'm nowhere near figuring it all out myself, so I have so much sympathy for you.
posted by Stacey at 12:34 PM on December 26, 2012 [1 favorite]


"Dad, I worry that Mum seems really sedated and out of it on her current medication plan. Have you two thought more about getting a second opinion from another psychiatrist? Is there anything I can do to help?"

That would be an appropriate way to express concern, but ultimately your mum is in charge of her own care and your dad's her second in command, so they're going to make the final decisions.
posted by Sidhedevil at 1:42 PM on December 26, 2012 [1 favorite]


You might want to check to see if she's taking her medication as prescribed.... is it possible she has the Xanax prescription to have on hand if she gets into a crisis, not as a daily medication?

Also, as an immediate family member, you can absolutely call her psychiatrist. The doctor won't be able to discuss your mom's condition without her permission, but that doesn't mean the doctor can't listen to your concerns. Try to do this close to her next appointment so the conversation is fresh in the doctor's mind.
posted by elizeh at 4:42 PM on December 26, 2012


I have bipolar disorder. I was diagnosed over 10 years ago, and during that whole time I have been tweaking meds. About four years into it, I found the mood stabilizer that has helped me the best (Depakote ER) but there are still symptoms I wish could be better controlled. Let me tell you, tweaking medications is an exhausting and frustrating process. Going up and down on meds, dealing with various side effects, and weighing if the symptoms or the side effects are the most bearable, all the while acting "normal" to the rest of the world, is wearing.

Your mother might just be glad that the symptoms are gone, and might be fine living with how she is now so that she doesn't have to go through that awful process of changing meds. After a while you feel like throwing up your hands and just settling.

I'm sure people remember me as more vibrant and energized before I started on meds. But all I can think of is the pain from those years. I'm sure I was charming and seemingly more alive while hypomanic/manic. But I was also an asshole, frankly. I would rather deal with side effects than go back to those years. You don't know if your mother views only pain when she thinks back to those pre-med times. I certainly do, in my life.

I hope my experiences help. You may not be understanding a balance that your mother has reached in order to finally feel some stability.
posted by veerat at 5:34 PM on December 26, 2012 [2 favorites]


I don't mean to imply that she is properly medicated now. Just that she may be settling, and why.
posted by veerat at 5:51 PM on December 26, 2012


I have bipolar disorder. Mood stabilizers eliminate all of my super powers. I can't stay up for days at a time, be extremely animated or super-productive, or fast for weeks. Thank god.

Xanax, 12 mg. That's an impressive dose. Withdrawal from that would be pretty intense in the short term, and the side effects of withdrawal can mimic mania or schizophrenia in the more severe cases. She shouldn't do anything different with this medication without medical supervision, nor should you suggest it. She may be overmedicated, but the only thing you can do is share your concerns with your parents and then drop it. You should contact NAMI instead, and go to one of the support groups for families/partners of bipolar sufferers.

The truth is that the current slate of treatment options for bipolar disorder is pretty shitty. Some stuff works for some people but not others, and no one really knows why. Sometimes medications will work for years and then stop working. I've been on lithium, Lamictal, at least a dozen different anti-depressants, anti-psychotics, anti-anxiety meds, even beta blockers. I'm still quite broken, and I've been trying to fix this for 25 of my 37 years.

I wouldn't love living in a haze, but that's me. I certainly wouldn't make decisions about my own treatment to make other people happy. Recently it was suggested to me (after a suicide attempt) that I should try electro-convulsive shock therapy. My treatment providers are generally in favor of it and my family is against it. I don't care what my family thinks; I'm weighing the pros and cons myself. They don't have to live with this soul-crushing, life-destroying disease. I do.
posted by xyzzy at 9:29 PM on December 26, 2012 [1 favorite]


it is unlikely that she is using Xanax as a daily medication at that level if it's supposed to be as needed. Xanax is a controlled substance, and if she used more than she was meant to in a 30 day period, she would run out of the medication before she could get a refill, and she would go into (potentially severe and dangerous) withdrawal.

I cannot comment on her psychiatric treatment and whether it is appropriate, but I do think a second opinion is a great idea if you can make it happen. However, there is only so much you can push before it becomes disrespectful of your parents' wishes. If they have crossed the line from disinterested in what you're saying to irritated or upset about it, you've gone too far.

I would suggest if you try to talk to them further about it, you don't say things about how much better you used to like your mom before her mood was stabilized and how much more a dynamic person she used to be. I bet she is well aware of the difference. One of the biggest challenges with treating people with bipolar disorder is convincing them to stay on the medications they need so that they can stay safe and functional. Going off the meds because they miss being manic can send them into a major tailspin that is dangerous for them and could easily end in hospitalization. Your encouragement in that direction would not be a good thing.
posted by treehorn+bunny at 9:41 PM on December 26, 2012


IANAD but I have family members who take Xanax (for anxiety).
One thing to consider is that Xanax is not supposed to be used long term because tolerance builds up fairly quickly. A few months into taking it the xanax will probably start losing effect and she will likely have to increase her dose or she will start feeling more agitated. 12 mg/day is an extremely high dosage - I'm a 200 pound male and I almost never take more than 0.5 mg/day. Weening off of that dosage would probably take a long time, and if she suddenly stops taking it she could have serious withdrawal. I would definitely discuss this with your doctor and make sure the medical personnel know about her dosage when she has surgery.
posted by banishedimmortal at 6:36 AM on January 1, 2013


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