About the meds, serious psychiatric illness often requires multiple medications to treat. The drugs are tried and discarded and tried again. Different combos are tried. Sometimes you may have (using the benzos just as an example) klonopin for daily use, Ativan for panic attacks and Valium at night. I personally have a low opinion of ambien, for another ex, but sleeplessness is sometimes very hard to treat, and days without sleep is bad too.
I know it may seem mind boggling, but her prescription list is not that strange to me. It looks like she was trying everything, like her psych was aggressively treating her illness- did they make the right calls? I don’t know. Did her medication profile contribute to her actions? I don’t know. But clearly she needed meds and they were trying to get her some. A severe crisis is not the time when psychs say ok, let’s take as little medications as possible.
Jmo ime
Agree with all the above.
This discussion about meds is a huge one.
We have to remember that each patient reacts differently to each medication and one agent that might do nothing for you or your friend might be the perfect treatment for someone else. You won't know that until you have tried, hence the trial and error approach with medication combos.
Looking at the list of meds they tried I get a sense that sleep issues and depression were prominent. She was tried on multiple sedatives / hypnotics and even the antidepressants chosen were ones that are traditionally used to treat a combination of depression with insomnia where sedation is wanted (mirtazapine, trazodone).
Yes, the SSRI generally used more frequently is sertraline (Zoloft) but fluoxetine (Prozac) is preferred in younger patients and gives fewer discontinuation symptoms (unpleasant symptoms you get when you get weaned off an antidepressant), which could have made it a better choice if the doctors knew they might have to try a lot of meds in a short period of time.
The combination of mirtazapine + SSRI is one used in treatment resistant depression, maybe this is why they tried it.
Yes quetiapine is used for a lot of different things, it is an excellent medication for Bipolar disorder to balance and stabilise mood, it is used a lot in schizophrenia. Lamotrigine is also very frequently used in Bipolar for prominent depressive episodes.
However having said that, I haven't seen anything to suggest that LC had a previous diagnosis of bipolar or that she was on these meds in the past.
Antidepressants are usually avoided in Bipolar patients, because they can tip you over to mania - and LC had a lot of antidepressants prescribed/ tried which for me makes the bipolar diagnosis a little unlikely.
For a bipolar patient I would expect to see a list with fewer antidepressants and more antipsychotic/ mood stabiliser choices - I would expect to see more quetiapine, olanzapine, lamotrigine, lithium.
In my opinion, this list points to a treatment plan for Postpartum depression with postpartum psychotic symptoms as well. The psychosis could have just been emerging, hence only quetiapine tried.
I am not clear on whether she was an inpatient or not, I have read both versions. Also read that insurance declined to cover inpatient admission which makes sense because I don't know any psych doctors who would willingly choose to treat postpartum psychosis (a true psych emergency) on an outpatient basis.
This is all JMO and speculation, I guess we might find out more as more details become known.