Hi Dr. Phelps,

What is your opinion of Trazadone for a person with BP?  My son has been taking it to help with sleep...the pdoc says "as needed" but isn't Trazadone an antidepressant? What have you seen as commom side effects of this med?

Also, what is your favorite form of Lithium to give to your patients? Lithabid,  Escalith or regular Lithium? My son is having nausea and his lithium level is .8. He is on regular Lithium Carbonate.

Thank You for your kind response....Jayne

Dear Jayne -- 
My favorite lithium by far is Lithobid because it's smaller than Eskalith so we can move doses more smoothly (you can even cut it in half although it loses its slow release properties then and becomes a more expensive, though more flexible, version of lithium carbonate.)  I have definitely  seen people who have trouble with regular lithium do better on Lithobid, so much so that I routinely start with Lithobid to make sure that if people "can't tolerate" it, at least they had the best shot at it I could give them.  I sound like I work for their company, no?  No bucks from them yet (I'll admit I'm working on that for my website, but that's true for all the mood stabilizer manufacturers).  I should say that lithium carbonate is fine for anyone who can tolerate it without difficulty, which is probably the majority of people on relatively medium doses such as those producing a blood level of 0.8. 

As for Trazodone, I'm not really sure what to do with that.  It seems not to produce the kind of instability and rapid cycling of other antidepressants (perhaps because it's so sedating people often don't really get into the dose range required for it to act like an antidepressant, like 300mg).  And it clearly helps people sleep, often much better than other options.  So, should one worry about it "destabilizing" bipolar disorder like other antidepressants?  I'm not sure.  I avoid it as a long-term solution on general principle, but have not seen other mood experts writing on this issue (and to my knowledge there's no research at all to go on).  

Dr. Phelps