Psych Central

Do I Still Need Antipsychotic Medicine?

By Kristina Randle, Ph.D., LCSW

I was finally diagnosed in April 2008 with both Bipolar Disorder and Borderline Personality Disorder, after hiding this and not getting treatment for my entire 29 year life.

I became very unstable in the summer of 2008. I was highly suicidal, and had three suicide attempts and one manic episode in a two month period. I was hospitalized three times.

My psychiatric nurse practitioner put me on Zyprexa to stabilize me. It did work. But I also gained 80 pounds and became almost diabetic.

She finally switched me to Invega which doesn’t cause quite as much weight gain. I did lose 15 pounds quickly, but then gained it all back. It doesn’t help that I am also a binge eater and food addict.

The Invega makes me extremely tired for a full 12 hours from when I take it. I have to plan my entire night and morning around it. I am not able to drive anywhere after I take it, because I am too drowsy. So I cannot do any shopping or errands after work at all, or attend any events. If I forget to take it until too late, then I’ll sleep too late and be late for work or be very groggy the next morning. I just started a new job and cannot afford to be late even once. But if I skip just one pill, then I do not sleep at all the entire night. Zero hours at all.

I have been getting free samples because I was unemployed. But I now have a full-time job, so she said she may stop giving me samples. Even with insurance, the Invega costs $350 a month. I was unemployed for 9 months, and before that I was in & out of the psych hospital for several months so I missed a lot of work and racked up a lot of medical bills. I also had some crazy spending sprees before I was stabilized. And all our savings is tied up in a bad real estate decision. So we are not doing well financially. There is no way I can pay $350 a month. Yet we are not low-income enough on paper to get assistance from the pharmaceutical company.

And beyond the cost – I don’t truly understand why I still need an antipsychotic anyway. I have never been psychotic. I have only been manic for brief periods. I was unstable in 2008, but I have been very stable for over 18 months with no suicidal thoughts whatsoever. I am also heavily medicated with 400mg of Lamictal and 1200mg of Lithium. Do I really need Invega? Why?

I asked her about this twice recently, and she doesn’t really give me a clear answer, she just says I still need the Invega.

Do you think I still need Invega? Why or why not?

How do I get her to listen to me or at least explain why I need it?

A. I cannot know with certainty what medication would work best for you. Your doctor may be in the best position to adequately answer your specific medication questions. I can only give you a general answer.

You have never been psychotic and you do not believe the medication is helping. Because of this, an antipsychotic drug may not be needed. On the contrary, some doctors prescribe antipsychotics for nonpsychotic disorders and some patients have found them helpful. Results vary from individual to individual.

You mention the fact that you have gained a substantial amount of weight. The medication is also making it difficult for you to function at your new job. These are serious concerns which need to be addressed. If your doctor is not willing to alter your medication or answer questions about why you need to be on a particular drug, then I would suggest seeking a second or third opinion. Your doctor may be concerned about you relapsing, possibly attempting suicide again or trying to keep you out of the hospital. Those are legitimate reasons to continue prescribing a medicine but if there are negative side effects then alternatives need to be explored. If she is not willing to adjust the medication, then you may want to consult another doctor.

Based on your letter, it seems that medication is your only form of treatment. I would strongly urge you to consider psychotherapy. Medications can be helpful but in many cases they work best when the individual is concurrently in therapy. How would therapy benefit you? Therapy, for instance, could help you address the reason why you tried to commit suicide. There is a reason for why you attempted to end your life. It’s a very serious matter that should be explored in depth.

Therapy could also address issues related to decision-making. You stated that at least in part your current problems are related to prior bad decisions in regards to real estate as well as spending sprees. You and the therapist could explore what led to those bad decisions. He or she could help you to alter your thinking and learn how to make better decisions in the future. Gaining better decision-making abilities could be a very important step in improving your life now and in the future. No one can be free of mistakes but the goal of everyone should be to make as few as possible.

I hope I’ve answered your questions. I truly believe that therapy could be very beneficial to you. Beginning therapy does not mean that you have to stop the medication; you can and should do both. In fact, it should be a major component of your treatment. If you would like to find a therapist please consult this directory. You may be able to find a local therapist who can address your needs. I wish you the best of luck.

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Last reviewed: By John M. Grohol, Psy.D. on 10 Jan 2010

APA Reference
Randle, K. (2010). Do I Still Need Antipsychotic Medicine?. Psych Central. Retrieved on April 18, 2014, from http://psychcentral.com/ask-the-therapist/2010/01/10/do-i-still-need-antipsychotic-medicine/

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