Expert: Ivan Goldberg, M.D. - 2/13/2009

Question
I have taken the Prozac/Lithium combination in the past and it worked great except that I felt numb, NO ups, NO downs, just numb.  I couldn't live like that so I stopped taking the Lithium.  I still take Prozac, but it doesn't seem to be enough.  I need some sort of mood stabilizer that doesn't cause weight gain and that numb feeling.  I also took Ritalin to improve concentration, but unfortunately that caused a prolonged manic episode, although it did help me lose the weight.

Is there a better combo than Prozac/Lithium that really works?  I would rather just take my chances with Prozac only than go through more trial-and-error getting the "right" combination.

Bi-polar sucks!  Just thought I would throw that in.

Thanks,
Clark

Answer
Hi Clark . . .

There is no doubt that having bipolar disorder sucks.

As you probably know there are two major subtypes of bipolar disorder . . . Type I and type II. People with type I have episodes of depression and episodes of mania. Those with type II have just as severe depressions but rather than episodes of mania, they have episodes of hypomania. Hypomania is similar to mania but less severe. One does not miss time from work or school or require hospital care.

If people with type I bipolar disorder take an antidepressant such as Prozac without a mood stabilizer such as lithium they will have one or more manic episodes . . . those with type II bipolar disorder can often take just an antidepressant and control their depression that way.

Mood stabilizers, other than lithium, that can be combined with antidepressants for people with type I bipolar disorder include Tegretol, Trileptal and Depakote.

Best regards . . .

Ivan
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