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The article “Depression, medication and ‘bad blood’” (Current Psychiatry, May 2007) discussed a case of reduced white blood cell (WBC) count in a patient the authors ultimately diagnosed as having a mood disorder with depressive features secondary to a general medical condition. However, I believe the authors missed the extent of the patient’s manic features.
The first clue was that the patient had “become increasingly irritable and volatile, often arguing with a staff nurse and other patients.” This behavior possibly was iatrogenic and caused by venlafaxine treatment. The authors added lithium at a low dose of 300 mg bid (no lithium blood levels given). This measure was done to increase WBC count, but it fortuitously may have helped reduce manic symptoms. At follow-up, “after 3 months of continuous hospitalization,” the patient was still described as “at times oversensitive and combative.”
Missing manic symptoms because of nonclassical ways they can present is a major clinical concern. For example, a patient may feel irritable, hostile, or labile instead of expansive or euphoric. I wonder if this patient’s manic symptoms could have been better controlled with titrating the lithium dose and following up by monitoring blood levels.
Robert Barris, MD
East Meadow, NY
The article “Depression, medication and ‘bad blood’” (Current Psychiatry, May 2007) discussed a case of reduced white blood cell (WBC) count in a patient the authors ultimately diagnosed as having a mood disorder with depressive features secondary to a general medical condition. However, I believe the authors missed the extent of the patient’s manic features.
The first clue was that the patient had “become increasingly irritable and volatile, often arguing with a staff nurse and other patients.” This behavior possibly was iatrogenic and caused by venlafaxine treatment. The authors added lithium at a low dose of 300 mg bid (no lithium blood levels given). This measure was done to increase WBC count, but it fortuitously may have helped reduce manic symptoms. At follow-up, “after 3 months of continuous hospitalization,” the patient was still described as “at times oversensitive and combative.”
Missing manic symptoms because of nonclassical ways they can present is a major clinical concern. For example, a patient may feel irritable, hostile, or labile instead of expansive or euphoric. I wonder if this patient’s manic symptoms could have been better controlled with titrating the lithium dose and following up by monitoring blood levels.
Robert Barris, MD
East Meadow, NY
The article “Depression, medication and ‘bad blood’” (Current Psychiatry, May 2007) discussed a case of reduced white blood cell (WBC) count in a patient the authors ultimately diagnosed as having a mood disorder with depressive features secondary to a general medical condition. However, I believe the authors missed the extent of the patient’s manic features.
The first clue was that the patient had “become increasingly irritable and volatile, often arguing with a staff nurse and other patients.” This behavior possibly was iatrogenic and caused by venlafaxine treatment. The authors added lithium at a low dose of 300 mg bid (no lithium blood levels given). This measure was done to increase WBC count, but it fortuitously may have helped reduce manic symptoms. At follow-up, “after 3 months of continuous hospitalization,” the patient was still described as “at times oversensitive and combative.”
Missing manic symptoms because of nonclassical ways they can present is a major clinical concern. For example, a patient may feel irritable, hostile, or labile instead of expansive or euphoric. I wonder if this patient’s manic symptoms could have been better controlled with titrating the lithium dose and following up by monitoring blood levels.
Robert Barris, MD
East Meadow, NY