Expert: Ivan Goldberg, M.D. - 8/7/2007

Question
I have been taking 5 mg Abilify for two weeks for rapid-cycling bipolar.  Previously I was taking 1000 mg of Depakote and 2.5 mg of Zyprexa.  I went off the Depakote a couple months ago with no issue.  I switched from the Zyprexa directly to the Abilify just two weeks ago.  I'm noticing that I actually feel more anxious on abilify.  Also, I'm getting some depression.  Is this something that is usually alleviated with a higher dose of abilify?  I'm going to talk to my psych MD about it, but he's on vacation right now.  I don't want to go back on Zyprexa, it caused me to gain 25 lbs in 2 months.  I've already started losing weight on the Abilify and would like to continue to use this med if possible.  I'm also supplementing the Abilify with Klonopin, which I find I have to use 1.5 mg or more a day to stay "in check".  I hate to be vain about the Zyprexa but being the weight I am is causing some self-esteem issues since I've always been a very healthy weight.

Answer
Hi Kristin . . .

Please do Google searches on:
"metabolic syndrome"
"tardive dyskinesia"
"neuroleptic malignant syndrome"

Because of these side-effects of antipsychotic drugs such as Abilify and Zyprexa I do not like to prescribe them for people with bipolar disorder, unless no other treatment works.

In my practice I can almost always control rapidly cycling bipolar with a cocktail containing various combinations of lithium, Tegretol, Lamictal, Keppra, and/or Zonegran.

Of course, if your bipolarity is accompanied by psychotic symptoms such as hallucinations or delusions, antipsychotic medication may be necessary, not as mood stabilizers, but to control the psychotic symptoms.

Best regards . . .
Ivan
%%%%%%%%%%%%%%%%%%%%%%%%%