Expert: Ivan Goldberg, M.D. - 1/28/2009

Question
Hello doctor.
I have been depressed what seems like my whole life. In August I moved back to NJ from AZ and within a week I was physically and emotionally paralized. I did not drink or eat for 3 weeks and lost 31 lbs.I wound up on the psych ward and was released 3 days later and went to intensive outpatient program. I was diagnosed with bipolar and depression. I have been taking meds for 5 months now and I am feeling better but I am still not happy I can't remember anything I shake all the time there is no way I can work I feel to stupid and insecure. I am taking cymbalta 120mg., depakote 1000mg,and trazodone 200mg at night because I have always had trouble sleeping. What do you think about these medications and do you know of any others I should try? Also, I am immune to certain meds. I know a couple of young people from my outpatient program that are getting electric shock what do you think about that? I am 48 years old and sick of living like this. Never suicidal. Thank you in advance.

Answer
Hi Colleen . . .

The best treatment for people with depression of any sort including bipolar depression is the combination of psychotherapy and psychopharmacologic therapy. While electroconvulsive therapy (ECT) is the fastest way to feel better, people who have a course of ECT either have to continue to have one ECT treatment per month or they have to take medications to prevent a relapse into depression.

When treating people with bipolar depression I often start with the combination of lithium and Lamictal and sometimes augment this with small doses of thyroid. There are many other innovative treatments for depression including Mirapex, sleep deprivation, bright light therapy, and transcranial magnetic stimulation.

It may be a good idea for you to have a consultation with a psychiatrist with better than average skills in evaluating and treating people with mood disorders. A list of such psychiatrists may be found at: http://www.psycom.net/depression.central.psychiatrists.html

Best regards . . .

Ivan
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