Expert: Ivan Goldberg, M.D. - 10/14/2007

Question
Dr. Goldberg:  I wrote to you last November, 2006 and you have no idea how much I appreciate your answer.  I am now writing about my son.  He was stable with bipolar (1200 mg Tegretol)for 16 yrs. Now
after a hospitalization in Feb. 2007, he is still experiencing symptoms.  Daily, he takes 1350 mg Lithium,
800 mg Tegretol and 800 mg Seroquel.  Do you think something
could be changed or added.  Awaiting your answer.  Thanking
you, in advance

Answer
Hi, Frances . . .

I can only answer your quesiton in the most general terms as I have no idea what might work for your son. If after an episode, someone continues to show manic and/or depressive symptoms, these symptoms can often be controlled by a combination of mood stabilizers combined with antipsychotic medications and/or antidepressants. (I am one of those psychiatrists who think antidepressants are often useful in the treatment of people with Bipolar Disorder).

The types of changes I might consider for someone taking the medications your son is taking include:

1. Making sure that eating, sleeping and socializing are done on a fixed, scheduled basis;

2. Making surer that psychotherapy is continuing on a 1-2/week basis;

3. altering the lithium dose to achieve a blood level between 1.0 and 1/4 mEq/L

4. adding Depakote

5. adding Lamictal

6. substituting clozapine for the Seroquel

Best regards . . .
Ivan
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