Expert: Joyce A. Anthony - 12/29/2008

Question
My fiance was recently diagnosed with rapid cycling bipolar after 28 years of
suffering from this condition and being treated only for the depression. Since
July when he was diagnosed, he has been on numerous medications but
continues to cycle. He says that the depressions are worse than they ever
have and is considering coming off medications. I am very worried of course
as the episode in July was a severe mixed mania.

He also suffers from very significant anxiety which his psychiatrist is not
treating. He picks his nail beds of his thumbs constantly so that there is no
cuticle. He shakes even without the medications when there is an anxiety
provoking situation. He has trouble getting the words out and stutters as
well. Sometimes, he can't get the words out and has to end the conversation.

His medication history since July is as follows:
He was first put on lamotrigine, lithium and epival. He developed the rash
and then went into anaphylactic shock as a result of the lamotrigine so he
was taken off this. He continued on the lithium and the epival with the doses
changed numerous times to try to control the extreme tremors he continues
to experience.
When he recently had a very severe depression, he was prescribed cymbalta.
After 8 days on this he had to discontinue as he was becoming manic. His
depression had lifted, however. 3 weeks later, he is again in a severe
depression. Since the cymbalta, his psychiatrist has prescribed quetiapine
25-50 mg. at night to help him to sleep. He was taking clonazipam for this
but was not finding it effective.
I have two questions:
Are there any other medications that would better control his symptoms?
What is the prognosis if he were to come off all of his medications after a
severe mixed episode in July which required hospitalization?

Answer
Hi Winnie:

I really can't make medicine suggestions without knowing his medical and family history.  Normally I would suggest a combination of Lamictal and Seroquel-which show great results with those who have had many medicine problems.  You say he already tried Lamictal, however. Talk with the doctor who prescribes his medication and see if Seroquel may be helpful.

As for coming off the medication-I would strongly advise against that!  Many of these medications need gradual withdrawal and there is always the chance of causing a severe episode when they are stopped suddenly. Please tell him not to stop taking any of the medications without a doctor's supervision.

                      Joyce A. Anthony