Q:  Medication to Control Her Mania?

Hello,  My significant other is bi-polar. We have been together for 15 years.  She was on Mellaril and Depakote.  He liver started to fail and I was the one that informed the doctors about the extreme dangers of Depakote. They removed depakote and I ask them to put her on Geodon since it has few side effects with the exception of a QT delay.  She has been taken off mellaril and is now on imipramine and Geodon, but is still manic. She is a diabetic,low thyroid,overweight,high blood presure and high triglycerides. He blood sugar went back close to normal when they took her off mellaril.  What medication would you suggest along with geodon that might control her mania? Her doctors respect my input.  Thank You, 


Dear Mr. M' -- 
Well, here we are with a diagnosis of bipolar disorder and no mood stabilizer.  And an antidepressant. So here are some ideas. 

First, before I forget, exercise is a known antidepressant.  When you look for a substitute for the imipramine (also known to cause weight gain), consider that approach strongly. 

Second, it's time to consult the list of mood stabilizers and pick one.  Note that Trileptal has not been associated with causing liver enzyme elevations although in this case I'd proceed, but with caution (e.g. still checking enzyme levels, at least once).  It also has not been associated with weight gain, useful to know in this context.  

Dr.Phelps