Expert: Libby Bonner - 8/16/2009

Question
my father was diagnosed as bipolar about 20yrs ago!now for about 18months he has been having audio hallucinations & what his psychiatrist has said could be schizoaffective disorder.he has had lots of different antipsychotic meds but none have worked at the moment he is on amisulpride,olanzepine,lithium,clonazpam & more & isnt gettin any better..also do you think stelazine would be worth a try as they've helped him in the past.we are at our wits end with worry and my mam as his carer is finding it harder to cope everyday.thankyou in advance Marie.

Answer
I am not at all qualified to make distinctions among antipsychotic drugs, and I don't know the recommended order in which they would be tried.

However, in a brief Internet search, I found this info that might be helpful. http://www.faqs.org/health/topics/74/Antipsychotic-drugs.html

A question that I have, though, is whether each drug has been given adequate time to be proved useful, or not, as it was added, and whether only a single drug is changed at a time.  Probably he began on 2-3 meds; I am speaking of after that initial trial.  There would be the further issue of not adding meds endlessly until a great many are being taken....at some point a med, one at a time, usually, would be judiciously withdrawn if it was felt to have been of no use.

At the site listed above, they mention ECT only in passing....electroshock therapy.  It has had quite a revival here in the States in the last 15 years or so, and is quite differently administered than in the past.  You may need to consider it if no drug combos are working.  It could prove to be the answer.  Do get full info about it, and consider it with an open mind.  Whether or not it should be used, depending on your father's work, is another matter.....

About his work.  I'm not sure what recourses are open to you there.  You might want legal advice about whether and how to protect his job, pension, etc.   I don't know, of course, whether he is now off work, or for how long, or about how much his employer knows of his situation.

The last suggestions I would have about any meds:  you can find a great deal of info at rxlist.com, though no suggestions about the order in which meds should be tried.

The other suggestion is a question:  do you have "clinical pharmacists" in the UK?  Here, they would have extra training, including training w/ patients.  They would not be used so much to dispense medicines, as to work w/ doctors treating pts such as your father, who have proved difficult to treat.  They would also have extra training at researching medication issues.

I hope you and your family will find an answer soon.