Expert: Ivan Goldberg, M.D. - 4/4/2007

Question
Dear Dr. Goldberg,
I have had bipolar symptoms since I was 17. I have in one way or another controlled these symptoms to some degree. (Worked, finished college) I am now 36 and I have not been able to work for the past three years. I am currently taking Lamictal 200mg. Effexor 300 mg. Provigil 200mg. I felt ok for about three months. After this my symptoms came back. This has happened throughout my life. Am I resistant to these medications and what do you recomment I tell my Doctor. The problem is I have no money and I go to a place called Mental Health and Mental Retardation here in El Paso, Tx. It is free but my doctor is actually a nurse practitioner and I don't think he has alot of experience. I live miserably and dont know what to do. Is there any type of combination of meds which I can recomment to my Doctor?
Please Help!
Thank you,
Javier

Answer
Hi . . .

Unfortunately you may not be able to get first class treatment unless you can figure out how to be treated by a psychopharmacologist at a medical school clinic.

When I have patients with a clinical course similar to yours, the first thing I do is to measure the amount of Lamictal in their blood, 12-hours after their last dose. If the amount found is less than 6 mcg/mL the nest thing I do is slowly increase the dose to achieve such a blood level.

Best regards . . .

Ivan