Post Edited (mth) : 11/5/2008 6:00:49 PM (GMT-7)
Post Edited (mth) : 11/6/2008 9:27:42 AM (GMT-7)
The meds are working but I don't think the mental health team really understand why. It's very much a try it and see approach. But for info I have noticed the following.
The Sertraline is a low dose of 50mg per day. I'm not sure if this really is of any use other than in the depths of depression but my wife finds it reassuring to be on it all the time. During a manic phase I suspect she should not be taking it.
The Lithium is taken at 1000mg per day. That's a high dose and has removed the small highs between each major relapse and noticeably its removed or greatly reduced the phsychotic symptoms this time round. The Lithium is the main mood stabiliser and is taken daily as a preventative.
The Olanzapine is only taken when approaching or during a manic / depressive phase. This works well when my wife agrees to take it. Now anyone reading this reply will likely know that's the biggest issue. As in all relapses my wife has refused to take additional medication till the last possible moment, manic highs can be nice to the one with BP. That said when Olanzapine is taken at a high dose (15mg - 20mg / day) my wife has come down off the manic phase after about a couple of weeks. The normal procedure then is to reduce the Olanzapine slowly down to 2.5mg then nothing. This takes several months to achieve. We found stopping the Olanzapine too soon caused a repeat of mania or depression.
The Olanzapine is an anti-phsychotic aswell as a tranquilizer so it reduces the anxiety and paranoid thoughts and at the same time has a sedative affect. Taken at night it helps my wife to get a good nights sleep which in itself helps reduces the mania. Taken at a high dose of 15 or 20mg it slows my wife right down. This is particulary beneficial in the throws of a manic high as it reduces the risk to herself and that of myself and children. I think the best thing for my wife during mania would be to take 15 - 20mg Olanzapine daily for atleast 2 weeks and not reduce until signs of mania had subsided. Unfortunately I suspect this will never happen as mania itself seems to provide such a good feeling that my wife actually enjoys it and loses insight into the negative affect on family. In all cases so far Olanzapine has been started near the end of the manic phase and approaching the depressive phase that always follows.
The mental health provision where I live isn't all it could be. The medication is really the only treatment on offer. My wife sees a phsychiatrist once a year. The rest of the time she sees a CPN, community phsychiatric nurse (home meetings). The CPN's change frequently and some are definitely better than others. The CPN's aren't able to provide counselling either. I phone them each time my wife relapses and they ask my wife to take Olanzapine if they consider it necessary.
Good luck with your wifes med.