May 3, 2005
After 9 years "undetectable," I asked for a drug holiday 7/04. I moved to San Fran, and re-infected myself via needle. I'm not a regular drug user. I've been typed Bipolar II, BPD, and I have had at least 10 suicide attempts racked up since 2000, about 3 serious. Never before 2000, oddly. My CD4 is now 171 (18%), VL 300,000 (highest ever). The labs are getting worse fast: over a few months. Liver about 300, which is doubled since January. My psych MD is on holiday, and I am between HIV MDs. Therefore, no prophylaxis for PCP was offered when my CD4 was 198, 2/04. I did not know that advice was from an NP at the time. He was foolish, and I 'flirt with death.' I am really hard to treat, with psych meds. Most mood stabilizers make me more curmudgeonly; and I am already suicidal/self-destructive. True antidepressants make me hypo-manic; perhaps I need more inpatient time with this. So I was happy when my psych MD & I put together 100mg Provigil, 1mg Klonopin BID, and 25mg Seroquel HS. I found 50mg Seroquel to make me a bit depressive. I dumped the Provigil yesterday (taken since about January), because my liver is not happy. But I am already getting apathetic, and I almost want to get sick. I have a dry cough, and can envision my demise: it is seductive. Question: Since there is no doubt Provigil uses P450, etc., what meds would make a meet substitute? I liked the sharp focus I got from Provigil. Could you throw out a few safer-for-liver mood modulators that I can bring to the table next week, when my psych MD returns? She is very open-minded. Thanks for reading this. Scott.
Response from Dr. Horwath
If the diagnosis of bipolar is correct, then your best bet for a drug that is not metabolized in the liver is lithium, which is an extremely effective mood stabilizer and has metabolized exclusively through the kidney. It needs to be carefully monitored by you and your psychiatrist to avoid adverse effects, but is quite effective and safe when used properly.
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