Should a bipolar person look like they are on medication?

[MzFlavor]

My husband is 45 years old and diagnosed with bipolar OTHER just over a year ago.  He currently takes 250mg of Depikote twice a day and 1 mg of resperdol twice a day.  Although he says he feels better on this combination of meds, he appears over medicated. He recently developed a tremor in his hands, face and leg since starting it 3 months ago.  He moves in slow motion as if he's far older than he appears and sleeps a great deal.  I spoke with his doctor and she said she noticed the "slight" tremor during his last visit and suggested he start taking vitamin B6 to help in reducing the tremor. She also lowered the dose of resperdol from 2 mg twice a day to 1 mg twice a day.  She also wrote a consult for him to see a Neurologist about the tremor.  I'm trying to get my husband to seek a second opinion, but he refuses.  He said that he will request to go back to Abilify because he didn't have the tremor after being on it for several months.  I'm not comfortable with my husband’s doctor because of her treatment plans over the last year.  He doesn't want to see another doctor because he's comfortable with her.  He was initially on Lithium and developed a very bad skin condition and protein in his kidneys.  She didn't change his meds until the labs shows the potion in his kidneys.  This week I'm looking for a new doctor for a second opinion. It breaks my heart to see my husband this way. Everyone who knows him is constantly asking what is going on with him.  He looks and acts like he should be on a ward in a state hospital. When a patient is being treated for bipolar should they appear to everyone around them to be on medication?   There are many famous people who are bipolar and you would never know it without them telling you. Does he have to look and act this way because he's bipolar? 

[Peter Forster]

I can certainly understand your concerns about your husband. I think of medication adjustment as an ongoing process for most people I see. But also a process that I try to do gradually unless there is an emergency. I don't have enough information to really comment about your husband's medications because there is such a range of response to medications, and such a range of susceptibility to side effects. I also agree with your concern about relapse... probably my suggestion would be that you encourage ongoing adjustment and fine tuning of his medications.

[Peter Forster]

The vast majority of people who are bipolar do not appear to be on medication to those around them.

[RoadBum]

Pete is right.  I've been on lithium for almost 30 years and no one knows I'm a bipolar till I start getting my football team jacked up.  Then they say he's got to be in Manic phase.  I keep my lithium level right at .05 which is the bottom of the therapuetic level.  I was a type 1 Bipolar (most severe) which is usually treated with lithium.  Type II is often treated with depakote.  Depakote and lithium are used to keep the person from going up into manic phase.  If they never go into manic phase they will never go into depressive phase because the depressive phase is caused by the rebounding affect from the manic phase.  So once a bipolar is stable he should never need an antidepressant.  Uni polars on the other hand have no way to prevent the depression so unfortunatley antidrpresants become a way of life.  Good luck, keep plugin and it will get better!!!
Bob

[MzFlavor]

With the information I provided does it sound as if my husband is over medicated or in need of his medications being adjusted? Also, is the tremmor a reason to stop or switch medications? He says he feels the best he's ever felt in his life and I don't want to interfere with that, but he presents with all the things I stated in my initial post.  My fear is he may relapse if I push the issue of adjusting his medications.

[MzFlavor]

Thanks for sharing your experiences and knowledge.  It was very helpful to me.

[MzFlavor]

Today my husband received a second opinion and the doctor felt he needed a medication adjustment. She said he should not appear to be on meds just because he's bipolar.  She also suggested he needs to decrease is Depakote because that it what is causing the tremmor.  She will do a report with her recommendations and forward it to his current physician.  If my hisband's current doctor  fails to incorporate these recommendation I will continue to encourage my husband to find a doctor that will listen.  I feel like a weight has been lifted since finding this site and receiving the second opinion today. Thanks again for all of your  insights and opinions. My husband is scheduled to see his current doctor in a few weeks and I will follow up with you all at that time.  Unfortunately, because we live and commute in two separate states, his primary residence is not here.  He is not here with me often enough to continue to see the doctor he saw today on a regular basis, but I will continue to seek the best care from him.

[Peter Forster]

Thanks for the followup. Glad the second opinion worked out.
Peter

[MzFlavor]

My husband went back to his primary psychiatrist and she adjusted his meds.  I saw an immediate response to the changes.  After a few days he even said he felt as if he was thinking clearer.  He also said the trimmer has decreased.  He told her he got a second opinion but gave no credit to their recommendation for her decision to decrease the Depikote.  I felt had she knew the Depikote was the cause she would have never decreased the Risperdal initially. At any rate he's tolerating the change well and I'm happy with the result.  I still feel he needs to seek therapy with another doctor.  

[Peter Forster]

I am glad that your husband is doing better.
I am certainly a big believer in the value of therapy. Although it is often hard to find a good therapist. Especially someone familiar with the treatment of bipolar.