Expert: Ivan Goldberg, M.D. - 12/12/2011

Question
Dear Dr. Goldberg,
I am a fan of yours on allexperts.com, and read your responses occasionally & ask you several questions about my sister(we are in Kenya, e.Africa). One time you did get annoyed at my question about Equetro vs. CBZ (FDA approved vs. FDA not approved)
Now , i know you are not a big proponent of Anti-psychotics due to side effects like tardive dyskinesia & NM Syndrome.
My question to you is which anti-psychotic would you recommend for schizo-affective disorder ? or bipolar with psychosis in addition to mood stabilisers like lithium,lamictal?? according to me , you would as a dr. give the best caring advice, unlike multinationals who just promote for the sake of it.
Thanks,

Answer
Hi, Shritesh . . .

I am sorry that I became annoyed at you in the past. I'll do my best not to allow that to happen again.

You are correct that I am not happy with many psychiatrists who use antipsychotic (neuroleptic) medications to treat individuals with nonpsychotic problems. When it comes to the acute treatment of individuals who manifest psychosis, I have no problem prescribing antipsychotic medications. All antipsychotic medications are not equally effective. The two that work the best are clozapine and olanzapine. Typically, these are also the two antipsychotic medications with the greatest potential to cause side-effects. Despite the possibility of side effects, if someone in my family were sick with a psychotic illness, these are the drugs with which I would like to see them treated.

Best regards . . .

Ivan
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