9 yr old son first dx w/severe ocd, depression,anxiety, skin picking Jan of 2000. Akathasia side effect to all ssris, effexor, anafranil, and antipsychotics... Dec 2001 dx w/bp. Thought now is that it was mania and not akathasia. Trial and error w/meds because he needs the anafranil for the ocd but seems to rapid cycle daily.  Current meds are 175mg anafranil, 30mg buspar, 600mg lithium and 1.5mg risperdal.  Still rapid cycling but not as much, ocd and skin picking stable, hallucinates occasionally, depression still present but not suicidal any more. What are your suggestions for a child w/comorbid dx of ocd, anxiety and bp?


Dear Ms. A -- 
I remember hearing several years ago some expert type saying that the combination of OCD and bipolar was a bad one because the AD's one needs for the OCD can cause the BP to cycle.  However, in my experience, if one targets the bipolar disorder primarily, there's a chance that what looks like OCD will come under some degree of control.  I've seen that happen at least twice.  Further, if one then, after establishing that the "bipolar part" (to the extent that you can separate these, which I think is probably not really accurate) is under control (no cycling, no obvious bipolar symptoms like sleep problems, irritability, profound depression/anergy); then cautious reintroduction of the antidepressant may allow for identifying the optimum balance of OCD control versus BP dyscontrol, as the AD is increased.  That' how I go about it, anyway.  See what your son's doc' thinks about that; she/he may have a different, equally legitimate approach.  

Dr. Phelps