Expert: Libby Bonner - 4/11/2009

Question
Thanks so much for responding so quickly.  Jim was brought to the hospital in 1998 by police.  in 2006 Jim stopped taking his meds.  Within 6 months a clinical depression set in.  At this time he went back on the neurontin and tried celexa as an antidepressant.  The first episode of mania has been thought to have induced a manic episode.  Doc at the time agreed.  Unfortunalet Paxil seemed to be the only antidepressant to lift the depression.  So again Jim went back on Paxil 30 mg.  The doc told me this was the highest dose he had placed Jim on.  Been Jim's doc since 1999 afetr first episode.  Sure enough within a few months the mania was back.  Jim's siter called police and Jim was arrested for harrassment.  Jim ended up in jail after violating an order pf protection (arguing with sister).  In jail for 30 days in which time he passed a 730 examination.  There were 2 manic episodes between 1998 and 2006 and 3 depressions 1in 1998, another in 2006 and another in 2007 when beginning to take lamictal.  Jim decided to stop taking the neurontin in place of lamictal.  Not Doc's advise.  I will look into the info you gave me.  I just wanted to give you accurate info.  JIm's current meds are 1800 mg neurontin daily, 15 mg. paxil, and 50 mg seroquel.  Jobs have been difficult for him to maintain but he is working now and seems like hi is doing alright.  Thanks for you help.

Answer
Just responding in general to your information.

If he is considered to be bipolar, and apparently he is, then I'm not sure what the neurontin is for.  But I'm not a doc.

Second, bipolar depressions are treated differently from "plain" depression....antidepressents are used cautiously w/ bipolars since they can trigger mania.

The thrust of treatment is establishing stable mood.  Usual bedrock meds would be lithium [and/or lamictal] and possibly one of the anticonvulsants, Depakote or Tegretol.  Atypical anti-psychotics are used as needed.

Steady work will probably continue to be difficult.

He might benefit from care from providers other than just a doc.  A community mental health center might offer some help with stability and with aspects of self-management of his illness.  NAMI has an excellent free class for "consumers" [patients] called Peer to Peer, and some locales now offer NAMI Connections for consumers - hour-and-a-half a week.  See nami.org.

I think he can find his nearest mental health centers at samhsa.org.