DEAR READER: Side effects of Abilify include a possibility of tardive dyskinesia (TD), involuntary, repetitive movements of the limbs, trunk and facial muscles. Abilify has been around for fewer than 10 years, so long-term effects are essentially unknown. But the product has so far been shown to have a much lower risk of TD when compared with older antipsychotic drugs.

Your son may also experience weight gain, which can likely be controlled through diet and exercise.

Bipolar disorder generally requires lifelong treatment, even during times when a patient is seemingly symptom-free. A person will likely be under the guidance of a psychiatrist and perhaps a therapist or psychiatric nurse. Medication helps by balancing emotional ups and downs and may include antipsychotics, antidepressants, anticonvulsants and a number of others. Finding the right medication or combination thereof may take some time; however, it will be worth the wait. Alternative therapies that can be used in conjunction with prescription medications include massage therapy, acupuncture, certain herbs, yoga and tai chi.

The exact cause of bipolar disorder is unknown, but it appears to occur more often in relatives of people who also have the disorder, suggesting a possible genetic component. The condition, once known as manic depression, causes mood swings that can occur several times a day or once or twice a year.

There are three subtypes known as type I, type II and cyclothymia. The severity of symptoms varies from person to person and is based upon which type of disorder he or she has. Cyclothymia is the mildest type that can include disruptive depression and hypomania, a condition of overexcitement. Subtype II may be associated with irritability and periods of depression. Bipolar I is associated with manic episodes that can be both dangerous and severe. A person may have difficulties at work, school or interacting with other people. Depression, manic symptoms and hypomania can also occur at the same time, and are known as mixed episodes.

Symptoms for the bipolar patient might range from agitation, ADHD, irritability, risky behavior, rapid speech, poor judgment and performance at work or school, to periods of euphoria, an increase in physical activity, increased urges to perform specific tasks and an increase in sex drive. The depressive phase may include sadness, suicidal thoughts, anxiety, insomnia, fatigue, loss of interest in one’s surroundings, an inability to concentrate and feelings of guilt.

In order for a person to be diagnosed as bipolar, he or she must meet the criteria established by the Diagnostic and Statistical Manual of Mental Disorders (DSM) as published by the American Psychiatric Association. In simple terms and depending on the subtype, a cyclothymic disorder must last two years or more with several hypomanic episodes and periods of depression but without a full manic, major or mixed depressive event. Bipolar II is based on at least one major depressive and at least one hypomanic episode. Bipolar I is based on having at least one manic or one mixed episode.

Manic episodes are defined as abnormally and persistently expansive, elevated or irritable moods that last a week unless hospitalization is necessary. Then there are symptoms a psychiatrist will look for to further substantiate the diagnosis. Hypomanic episodes are defined as moods of worsened irritation that last at least four days and are distinctively different from the usual nondepressed mood. Again, specific subrequirements must be met. With major depressive episodes, a person must undergo five or more specific symptoms over a 14-day period with specific features being met. Mixed-episode diagnosis is based on manic and depressive events nearly every day for at least seven days.

Because your son’s care should be under the direction of a psychiatrist, I am sending you a copy of my Health Report “Medical Specialists.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order made payable to Newsletter and mailed to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

DEAR READER: Medications can definitely cause feelings of sadness, despair and discouragement. All are feelings commonly associated with depression.

The metformin you were prescribed is commonly used to treat type 2 diabetes or pre-diabetes. It helps control the amount of sugar in the blood and decreases the amount of glucose absorbed from food and the glucose made by the liver. It can also be prescribed to regulate menstrual cycles but does not prevent pregnancy. Common side effects include nausea, vomiting and diarrhea, but not depression.

Your polycystic ovary syndrome (PCOS) can cause erratic or prolonged menstrual cycles, obesity, acne and excessive hair growth. Women with the diagnosis may have difficulties becoming pregnant because of the infrequency of ovulation.

My guess is that you were prescribed birth control to help regulate your cycles, because low-dose birth control with a combination of synthetic estrogen and progesterone can decrease androgen production, correct any abnormal bleeding, and decrease your risk of endometrial cancer. An alternative to this would be to take progesterone for up to 14 days every month, which will reduce your risk of endometrial cancer and regulate your menstrual cycle but will not improve your androgen levels. Treatment for PCOS is geared toward management of obesity, acne, hair growth and infertility.

I don’t know if you have a weight problem as a result of your PCOS, but exercise will go a long way toward lowering your blood-sugar levels. Speak with your physician before beginning any exercise regimen. Request a referral to a gynecologist familiar with PCOS who can direct you in terms of treatment and your depression. Perhaps counseling is in line. A nutritionist can get you on the right track regarding your diet.

It appears you have a lot going on at 20 years of age. You deserve a better outlook, and the help is out there.

To provide related information, I am sending you a copy of my Health Report “Consumer Tips on Medicine.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order made payable to Newsletter and mailed to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

My ANA test for three years has come back normal, but I continue to get lesions, my hair falls out, and I get sick easily. I have been to two rheumatologists. Both say I do not have SLE, but my family doctor feels I do. What do you think?

I was also told that because I only have discoid lupus, this would not cause any health problems other than with my skin and hair. So why do I have it in my nose and inside both ears? I’m now 33, my bones are brittle, and I have osteoarthritis in my hands and fingers. Help!

DEAR READER: Whew, where to start? Some children have impaired immune systems, making them subject to numerous disorders. My guess is that you were unfortunate enough to fall into that category.

There are a number of forms of lupus, which is an autoimmune disease. Lupus can affect joints, skin, kidneys, brain, heart, lungs and other parts of the body. Common symptoms include skin rash, kidney problems, arthritis and unexplained fever.

Discoid lupus is a chronic skin disorder that shows as a raised red rash that ordinarily appears on the face and scalp but can appear in other areas of the body, including the nose and ears. The lesions may last for days or years and can recur. Some people diagnosed with discoid lupus may develop systemic lupus erythematosus (SLE) at a later date.

Because arthritis is a common complaint, it’s not at all surprising that you have been diagnosed with fibromyalgia, chronic pain in muscles and ligaments.

Pleurisy is swelling of the lung linings that causes pain and breathlessness during inhalation and exhalation. Causes include acute viral infections, such as influenza, and can be the result of autoimmune disorders, such as lupus.

Kidney stones and related infections have numerous causes, including dehydration, obesity, genetic factors and a diet high in protein/sugar/sodium.

Vertigo can be caused by an inner-ear disorder, migraine headache, acoustic neuroma and other causes.
Depression and anxiety can be caused by lupus, fibromyalgia, kidney stones and vertigo. You have a lot on your plate, and it has obviously resulted in a lot of stress. Osteoarthritis, a breakdown of cartilage, causes pain and stiffness of affected joints. The condition is commonly associated with the aging process, but at 33, you are far from old. Treatment is geared toward controlling pain through medication, rest, exercise and protection of the affected joint(s).

Because so many of your symptoms involve pain, I’m inclined to suggest that you be referred to a pain clinic for control or request a referral to a larger diagnostic center, such as the Mayo Clinic. You will learn methods for reducing the level of pain you presently experience that may include water aerobics and yoga. Appropriate medication might be ordered. Once you get that aspect under control, the anxiety and stress levels you are under may be reduced.

To provide related information, I am sending you a copy of my Health Report “Fibromyalgia.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

DEAR READER: Your brief inquiry could require far-reaching answers, since there is no single known cause for depression, which can be mild or so severe it heavily affects a person’s ability to function from one day to the next. It is my guess that you have never spoken with a physician about your concerns. If this is the case, you join the vast majority of people who never seek medical treatment.

There are a number of types of depression, including a psychotic form that accompanies delusions, hallucinations or some other form of psychosis. Postpartum depression affects women within a month following delivery. While quite common, it presents for a relatively brief period. Seasonal affective disorder (SAD) presents in the winter, when there is less natural sunlight. As you might have guessed, SAD remains under control during the balance of the year and can be treated with light therapy. Milder forms of depression aren’t as severe in intensity, and people may not be as disabled as with other types, but they will have an ongoing complaint of not feeling up to par, and they fail to function normally.

The severity, duration and frequency of symptoms will vary. Some people may experience a loss of appetite, a loss of interest in things once pleasurable, become irritable, have insomnia, aches, pains, headache, a feeling of hopelessness and a great deal more.

As can be expected, depression may co-exist with other medical conditions, such as Parkinson’s disease, cancer, diabetes, post-traumatic stress disorder, alcohol or drug abuse, and a family history of depression.

Fatigue can also stem from a number of causes. The first one that comes to mind is iron-deficiency anemia. Then there’s hypoglycemia (low blood sugar), a viral infection, hypotension (low blood pressure), abnormal thyroid function and an immune-system deficiency. You might experience muscle pain, occasional irregular heartbeat, headache, an inability to concentrate, morning stiffness and shortness of breath. If other causes cannot be found, perhaps you are suffering from Chronic Fatigue Syndrome.

The key to diagnosing chronic long-standing fatigue is that the symptoms remain, despite adequate sleep. If we couple this with the mild form of depression I mentioned above, these symptoms outwardly fit your profile to a T.

Having said this, I must strongly recommend that you make an appointment with your physician for a complete examination to include blood work, EKG, chest X-ray and anything else he or she recommends. If no abnormalities exist, and perhaps even if they do, request a referral to a therapist or psychiatrist to determine whether the cause is depression.

I know it’s easy for me to say you should undergo an expensive exam and follow-up testing. Money is always an issue, and the expense is a concern. However, living a life of fatigue and depression carries a gigantic price tag that you need to get out from under. Mild blood abnormalities might be eradicated with prescription medication. Depression, from mild to severe forms, can improve with treatment. I hope you weigh the odds and follow through. You owe it to yourself and to those you love.

To provide related information, I am sending you a copy of my Health Report “Medical Specialists.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

Please don’t suggest anti-depressants. Been there, done that. While they helped me a bit, I couldn’t tolerate the side effects. Besides, I am not depressed, so I don’t want to go on them. Do you have any idea why this happens?

DEAR READER:
Because you are 70, I would not lean toward menopause being the cause of your emotional swings.

Has something changed in your day-to-day living such as personal illness, a family member being ill, increased financial difficulties, losing a beloved pet or other stress? If this is the case, counseling might be in order. The therapist will not prescribe anti-depressants but can certainly guide you through this difficult period.

An uncommon side effect of a medication you are taking could be to blame. Speak with your physician. A simple switch to another drug in the same class may relieve the symptoms.

There is help available. The fact that you have written to me is an excellent start. Keep investigating until you have your emotions in check.

Bless his heart! He’s working 40 hours a week, and comes home to a nag who can’t understand why he’s tired. If taking naps is ruining a 50-year marriage, let her go! He may just perk up when her negativity walks out the door.

DEAR READER: I disagree with you. Sleepiness can be a symptom of depression, anemia, and a host of medical conditions that should be addressed. Perhaps the husband needs a sleep study to determine if his sleep pattern is disrupted several times a night. In my opinion, he should also have an exam by his primary care physician. If everything is normal, he may need counseling, but I don’t believe that breaking up a marriage is going to solve his wife’s anger and bring everything back to normal.

To give you related information, I am sending you a copy of my Health Report “Sleep Wake Disorders”. Other readers who would like a copy should send a self-addressed, 4 ¼” X 9 ½” letter-sized stamped envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.