Expert: Ivan Goldberg, M.D. - 10/11/2007

Question
Hello, I am a 39 year old female dx'd Bipolar 1 with psychosis. I have taken every pill that's out there, give or take a few. I am currently on Synthroid, Lithium and Paxil, with Prozac 2 weeks a month for PMDD. It has taken two years to find this combo. I have had so much trouble with side effects and non-performance and episodes of extreme mania when placed on certain anti-depressants, so I am now worrying about what happens when this doesn't work anymore. I have taken classes in DBT. In the event of a relapse, my question is what have you found to work well for treatment resistant patients? I would be most appreciative. Thanks, Rose

Answer
Hi, Rose . . .

Without a list of exactly what you have taken and the doses and the length of time there is no way that i can give you a personalized answer to your question . . . and even with that information i would not give you such an answer as that is not the purpose of this service.

The general answer to your question is that  people with hard to treat bipolar disorder, with or without psychosis, usually respond to a combination of medications that usually include three or more mood stabilizers and an antipsychotic medication. The most typical such combination that I use is:

clozapine   lithium   Tegretol   Depakote.

Best regards . . .
Ivan
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