Expert: Ivan Goldberg, M.D. - 3/8/2008

Question
Dr. Goldberg:
You've answered my questions before and I so value your wisdom.  My son, who has bipolar, took only Tegretol for 20
years.  After a hospitalization last year, he has been struggling.  Recently, he was prescribed Prozac and began experiencing obsessive thoughts for about l-2 hours/day.
This is a symptom which he never had before.  Proxac was
stopped 3 weeks ago and Luvox given but he still experienced the obs. thoughts.  Lyvox was stopped l week ago.  They said Prozac can cause these symptoms; can Luvox
also cause obsessive thoughts.  How long does it take for
Luvox to leave the body??  Thanking you once again for your
answer.  p.s.I love it when you speak at the NY MD meeting!!
FPavick@yahoo.com  

Answer
Hi, Frances . . .

One of the problems faced by people with a mood disorder is that the disorder can change over time requiring changes in the treatment. I am sorry to hear that your son is having a hard time.

I am not a fan of using antidepressants as a treatment for people with bipolar disorder. They induce the possibility of rapid cycling, mixed states, and/or a switch to mania.

The symptoms of OCD when seen in someone with bipolar disorder most often are related to inadequately treated depression. The depression in people with bipolar disorder is often best treated by a combination of mood stabilizers. For someone who has done well for many years with Tegretol such a combination might be:
Tegretol   lithium   Lamictal.

As far as your question about Luvox. After someone has been of of it for 2-weeks there are insignificant, microscopic amounts left in the body.

Best regards . . .
Ivan
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