Q:  Husband's Meds

My husband has bipolar disorder. He went through a major crisis a couple of years ago and the doctor he was with had him on lots of meds that he was abusing. After he calmed down, they put him strictly on wellbuterin which worked great for him for over a year. In the last few days he has lost it again. I think it's hyper mania?? His mind is racing, he's crying ALL the time, and then he gets paranoid and mad. It's a mixture of lots of lovely things. Anyways....he saw a doctor today that put him on Klonopin (5mg 3x daily), paxil (10 mg 1x daily) and neurontin (300 mg 3x daily). Doesn't that seem like an awful lot of medicine? She says he should feel better in a couple of days. What do you think?

Dear Amy -- 
If your husband truly has a bipolar disorder, and that's the new doc's diagnosis too (she could have found reason to think otherwise, perhaps), then this regimen is "off the map" of routinely recommended treatments for bipolar disorder and a second opinion is warranted.  However, both you and I should be careful not to conclude that the current regimen is some sort of error until you hear more directly about her the doc's diagnosis and her rationale for this regimen; she could know something we don't.  In that case, a second opinion could end up recommending the same regimen.  Here's a basic primer on bipolar disorder; and my primer on bipolar II; and the expert consensus opinion on medication approaches.  

Dr. Phelps