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Doctors' Answers to "Frequently Asked Questions" - Bipolar Disorder

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

Attention Deficit Disorder and Bipolar II [posted 1/14/99]
Question: Depakote/Cylert/Wellbutrin/Klonopin Interactions.
I just recently started taking Depakote for Bipolar II. My doctor had been giving me Klonopin, which was not much help. I have always had trouble sleeping and found that the Wellbutrin made me even more restless and edgy than I had been before (I was already a terror). My mood was very unstable and has always been. I was given Cylert for my ADD and have found it does not work nearly as well as the Ritalin I was originally taking. Unfortunately my mood really was affected when the Ritalin was wearing off. Not to mention I had lost over 10 lbs. in less than 3 months (at 5’ 5” I was down to 97 lbs.). My Psychiatrist thought Wellbutrin would help with the ADD. At that time I had gone through two severe losses of my grandpa in December and then my grandma in February. Needless to say I felt terrible and my ADD symptoms were very much there. I was put on Cylert and have been on it now for some time now and am not seeing any real improvement in my ADD. Plus, I had terrible insomnia. About 2 1/2 weeks ago I started taking Depakote first 250 mg/day. After 4 days that was upped to 500 mg and now it is at 750-1000 mg. It seems like a very rapid increase, but it seems to help. My temper and irritability are much better. I am taking these 3 pills all together at the same time 9, 1, and 6. The Klonopin I am gradually weaning myself off of, but I notice I am having trouble sleeping again. I have never taken anything that has made me tired enough that I fall asleep. My Cylert/Wellbutrin combo is not really working for my ADD either. My Psychiatrist is just really at a loss as to what he should do to help me sleep and address my ADD symptoms. I have a fairly serious past of 3 suicide attempts, plus a lot of other destructive behavior. What kind of drug interactions are associated with these medications? Maybe reducing the Klonopin is part of the problem. Also, my short term memory is terrible.

Answer: Well, reducing the Klonopin is probably contributing to the sleep disorder. However, if you can function without this drug you're probably better off. You might try melatonin for sleep, no obvious interaction with your other drugs.

Bipolar Treatment - Alternatives [posted 1/14/99]
Question: I have been taking Depakote and Paxil for a while now and have suffered from very heart-breaking side effects. I am getting off the Paxil ASAP because its side effects are intolerable. My question/questions where regarding the depakote and its side effects. I was wondering if depakote has any sexual side effects like the paxil, such as sexual dysfunction, ejaculatory disturbance, etc. I have not been able to have an orgasm since I was put on the paxil and depakote. I was hoping by getting off Paxil I could eliminate this problem. Could you please inform me of all the side effects of depakote because I heard that the manufacturers don't list all the side effects on the little insert information card thing. Is there any other drug I could take other than paxil for depression? I researched Zoloft and Prozac and found their side effects are pretty much the same as Paxil's. I take the depakote because I'm bipolar. Is there any other drug I could take with less or no side effects for bipolar disease other than depakote? (Or at least without the hair loss and weight gaining side effects) I am sorry for asking so many questions, but I am in desperate need of some expert advice because life on these drugs isn't worth living to me.

Answer: Depakote isn't notorious for sexual dysfunction, like the SRI antidepressants, but some will experience it. As to the sexual dysfunction, try Serzone, Celexa, Wellbutrin, and Effexor in about that order. St. John's Wort is sometimes very effective with minimal sexual problems also. It's worth a try.

Bipolar Disease Medication [posted 1/12/99]
Question: My brother has been diagnosed with bipolar disease. He has been prescribed the following medications: Buspar (10 mg) 2 tabs 2 times daily
Carbamazepine (200 mg) 1 tab 4 times daily
Effexor (37.5 mg) 1 tab 2 times daily
Lithonate (300 mg) 3 capsules in the a.m., 2 capsules in the p.m.
These medications have turned a handsome, vital human into a shuffling zombie. He is 50 years old, and married for the past 4 years (which is when the medicating began). How long can he take this combination? He has had to go on total disability as he cannot even carry on a full sentence conversation. Can you tell me how these drugs can be helping him? I see only the total deterioration of his body - physical and mental. I had thought of calling his physician. However, I suspect privacy laws would prevent getting any information from that avenue. Do you have any viable suggestions?

Answer: This shouldn't produce a zombie unless the carbamazepine levels are high or the lithium levels are off. Get them checked.

Bipolar Treatment with medications [posted 1/5/99]
Question:I am a student diagnosed with bipolar disorder. I was recently in the hospital for my condition and was prescribed Fluphenazine (Prolixin) and Artane (Trihexphenidyl). The information sheet I got is sparse with information. Your web site did not have these drugs listed and I was unable to find out who the manufacturers of these drugs are. I will ask my psychiatrist when I see him. I am just requesting additional information because your web site had great information on the allergy medication I take (Allegra).

Answer:Fluphenazine is made by about 5 generic firms, Geneva, Par, Pharmaceutical Associates, and Mylan. Artane by Lederle Labs: 800-934-5556.

Bipolar, mood disorders [posted 1/5/99]
Question: I have been taking lithobid, zyprexa and paxil since May of 1998. I recently was diagnosed as bipolar and depressed with rapid cycles. From May until now I have gained almost 50 pounds on the medication. Could you advise me as to which medication is causing the weight gain and what can I be treated with in their place that would not cause weight gain. I tried Tegretol for a month, but I started cycling severely.

Answer: Probably the Paxil. Serzone or St. John's Wort or possibly Effexor would be worth a try.

Bi-Polar Disorder and Medications [posted 7/16/98]
Question: My 14 year old daughter was diagnosed several years ago with ADD and LD and began taking Ritalin probably around age 7. As of approximately 1 1/2 years ago she also was diagnosed clinical depression and she was put on Prozac and Adderrall for depression and ADD. She was hospitalized recently for suicidal tendencies and some self-mutilation. Her psychiatrist tells me he hasn't ruled out bi-polar as a final diagnoses. This after adjusting the dosages of current medications listed above. What affect might the above medications have on bi-polar disorder, if in fact, that is what she actually has. She has been on 40 mg of Prozac for 2 months, and 30 mg of Adderrall since the same time. Her behaviors continue to be erratic. Do the medications not address bi-polar

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