Expert: Ivan Goldberg, M.D. - 12/22/2010

Question
Hey Doc-

Without getting into too many details, I live in a mixed mania hell.  I have recently returned to therapy and have managed to stay sober from drugs and alcohol for over 9 years with help.  Insomnia, racing thoughts while sleeping, restlessness, irritability, social anxiety, depression, hopelessness, thoughts everyone hates me, are among some of my day-to-day feelings.  

I recently started Depakote and want to avoid antidepressants b/c I think they cause more harm than good for me.  Depakote is helpful, but I want to talk with my pdoc about adding the right medications, what would you recommend for someone only suffering in the mixed episode biploar realm??

Thanks!

Answer
Hi, Nathan . . .

Many people who have experienced mixed (manic + depressive) symptoms describe it exactly as you do as "hell."  The control of such mixed bipolar symptoms usually requires a fairly complex combinations of medication. Medications that seemed totally useless then tried alone, often contribute to control of the mixed symptoms when used as part of such a cocktail. Many of my patients with the kind of mixed bipolar symptoms you describe do the best then taking a combination of lithium + (Tegretol OR Trileptal) + divalproex + lamotrigine.

Best regards . . .

Ivan
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