I have been bipolar for some time, but my last episode was particularly traumatic. I would be classed as Bipolar II in US. I had a manic episode which lasted almost 9 months. My meds were changed, Lithium increased to 1000mg, tegretol to 1400mg and large quantities of thioridazine, due to the fact that I reacted badly to haloperidol, droperidol and stelazine. I returned home, and am back working, but having problems with social phobias, and phobias regarding gas, electricity, plumbing, and stinging insects. At times this is disabling, especially the social phobia. I consulted my new doc (I moved to another country) and he wanted to put me on an anti depressant (cannot remember name)but I refused, as I react badlt to antidepressants, which send me into mania. Is there anything available which would help with the fears and phobias and anxieties, without inducing mania or disabling my ability to teach and do a day's work?

Many thanks,
Sarah

Dear Sarah -- 
In general I have found that mood stabilizers seem to help with anxiety and sleep.  At minimum I would rely on those for my patients until there were no signs of "mixed states" (agitation, irritability, severe insomnia, difficulty concentrating -- in my book).  At that point I will consider antidepressants.  I'm beginning to think Effexor has some specific value for people with obsessive negative thinking, more so than Wellbutrin, which is my usual "go-to" antidepressant because it seems so much less likely to destabilize things than other antidepressants (at least at tiny doses, which can often be quite helpful -- but I'm not so sure about it's anti-obsessive effects versus something like Effexor, perhaps because the latter has the "serotonergic" component Wellbutrin lacks).  

In general for folks who have required antipsychotics in the past I'm even more wary about antidepressants, and rely even more heavily on mood stabilizers.  

Dr. Phelps