i have suffered from bipolar disorder for 30 years.  it was only 10 years ago that i finally got a proper dx and meds.  over the course of those 10 years i have had to change meds many times because a) they didn't work in the first place, b) they quit working, or c)they caused weight gain.  Since i am a type II diabetic i think you will appreciate why extra weight is not a good idea for me.  i am bipolar I but have much more trouble with depression than mania.  i should also add that i am also being treated for anxiety, panic disorder, and ocd.  i am currently taking tegretol (1000 mg a day), neurontin (3000 mg per day), wellbutrin (400 mg per day), buspar (60 mg per day), and celexa (50 mg per day).  smaller doses do not work, and whenever i am taken off antidepressants, no matter how slowly,  my obsessions, compulsions, and panic attacks come back with a vengence.  not only that, it isn't too long before i become deeply depressed.  

i was unable to handle the stresses of a job i had in January and was fired.  i have been very depressed ever since.  i feel like i do nothing except eat and sleep and i have gained 20 pounds.  every time i try to do something i feel like i'm moving through lead.  i worry constanly that my husband is going to die, although his health is better than mine.  i obsess over the fact that my life has been a waste.  my doctor wants to substitute  paxil for celexa and topomax for tegretol.  we both feel i need therapy but our insurance does not pay for that and my husband can't afford to pay out of pocket.  we are lucky to be able to get the meds i need.   what do you think of using these meds?  she also thinks zyprexa might help if the others don't.  what is your opinion on using an antipsychotic in bipolar disorder?

Dear Ms. S' -- 
I'm afraid it would be inappropriate for me to comment on specific medications for you when your doctor, no matter what her expertise or opinions, knows you so much better than I.  As for antipsychotics, though: before we had multiple mood stabilizers, and only lithium, it was a standard thing to do to combine an antidepressant with an (old generation) antipsychotic.  Now we use the new generation versions, and Zyprexa in particular has clear-cut antimanic properties in most people, and an odd sort of antidepressant effect in quite a few.  Risperidone has some uses, and even Seroquel is a pretty good wet blanket when that's what's needed.  Geodon is too new yet, though a few folks I've seen have gone onto it from other sources and liked it in place of Zyprexa.  The rest of my opinions about medication approaches to bipolar disorder can be found on my website, in the "treatment" section of the material on bipolar II.  Good luck to you. 

Dr. Phelps