Expert: Ivan Goldberg, M.D. - 10/19/2007

Question
Thank you for your time.  I was diagnosed with depression and subsequently attempted suicide at 18.  Soon after that depression I had a serious manic episode.  I bounced back and forth on emotional while still being on an antidepressant.  Finally when I really fell apart they diagnosed me as bipolar in the hospital and I was put on Lamictal and Lithium.  I've had MANY medication concoctions since then (and a few more hospital trips).  Now I am on 180mg Geodon, 1500mg Lithium, 400 mg Lamictal and 10mg Lexapro.  I still have highs and some lows.  But finally to my question, I want to go on a "drug holiday" to see what is really necessary to keep me on the even.  My psychiatrist doesn't support me fully with that idea, but I'm so frustrated with being on so many different medications which I don't believe are all helping.  Sorry for this very long question.  I really need input.

Answer
Hi Emily . . .

Having bipolar disorder and being treated for it are, as you have discovered, very frustrating experiences. The illness causes much distress and the treatments are far for fully effective. In the 1960s and 1970s drug holidays were thought to protect patients from some of the long=-term side effects of medications, especially antipsychotic medications such as Geodon. It was then discovered that drug holidays increased the probability of developing tardive dyskinesia.

If a patient of mine, taking the medicationss you are taking asked me about a drug holiday I would be strongly opposed to the idea and would suggest that if the patient were doubtful about the usefulness of the medications, that we select one of the medications, slowly reduce the dose, and see what happened. If lowering the first medication causes a worsening in symptoms, we would restore that one to the original level, and gradually reduce one of the others.

Best regards . . .
Ivan
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