Expert: Ivan Goldberg, M.D. - 12/30/2006

Question
Hello,
I have a brother who has been suffering from manic depressive illness
since he was 20 years old. He is 43 now. He has been on lithobid and
thorazine. These medications have worked very well for him. The problem is
the last couple of years he's been having episodes even when he is
taking his medications. We had him tested last month and his lithium level
was above normal range, so he is taking 1 less pill now. The problem is
however he still is not 100% himself. He's fine for a week then he is
not..then same thing again.. Any suggestions? I am scared of changing his
medications for the fear of him getting worse.

Answer
Hi . . .

Whiel drugs such as lithium and Thorazine often do a good job they do not always do a perfect job. You do not describe howo your brother is not himself. I assume that he is either showing manic and/or depressive symptoms.

When people show manic symptoms, adding either carbamazepine (Tegretol) or divalproex (Depakote) to lithium and Thorazine often helps. Depressive symptoms are often well controlled by the addition of lamotrigine (Lamictal).

Best regards . . .

Ivan
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