Expert: Ivan Goldberg, M.D. - 7/27/2007

Question
Dear Dr. Goldberg,  For three years I have been in agony with Lithium related psoriosis. The problem is that I have tried many other meds and they have all caused MANIA and hospitalizations.  Is there a lithium substitute that is less likely to cause mania.  My doctor wants me to try yet another medicine and I am so scared.  I just can't bring myself to go through another drug induced episode.
Please send help.

Answer
Hi, Jodi . . .

I have found that it can be disastrous for someone with psoriasis to continue to take lithium. A very severe form of arthritis, psoriatic arthritis, that may be totally crippling can result.

In people with bipolar disorder, the medications that cause mania and hospitalizations are usually various antidepressants. There are a number of medications that like lithium, act as mood stabilizers. Such medications protect against mania rather than cause it. Among the mood stabilizers are:

Tegretol
Depakote
Lamictal
Trileptal
Keppra
Zonegran.

While I am not enthusiastic about the approach, many psychiatrists also prescribe antipsychotic medications such as Zyprxa and Seroquel as mood stabilizers. I am not enthusiastic about this way of controlling bipolar disorder, because of the danger of tardive dyskinesia and neuroleptic malignant syndrome (Research these via Google).

Best regards . . .
Ivan
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