Q:  Can't Seem to Find the Right Meds

I am 34 yoa and was diagnosed with bipolar in 1999. Since that time I have left my husband 3 times and even went as far as divorcing him. We are together now but I am tired of this illness ruling my life. I see a psychiatrist almost every other week and a counselor monthly. No one can seem to find the right meds to help me. My doc says that my chemistry is backwards or uniquie!! I have tried almost every antidepressant known to man and am now on Lexapro. I also have tried numerous mood stabilizers and antipsychotics with still poor results. I have a very hard time with side effects. My doc has now referred me to Iowa City University for further evaluation. I have given up hope. Do you have any suggestions for a treatment. I presently am taking Lithium 600mg  Depakote 500mg  Lexapro 10mg  and Klonopin .5mg 

Thanks


Dear Wendy -- 
For folks like you, my first question is always "have you ever had a period of time when you were on mood stabilizers (like lithium and Depakote) without an antidepressant at the same time.  That, in my view, is the starting place, and any mood stabilizer mixes you've tried along with an antidepressant would have to be tried again without the antidepressant to make sure they really "didn't work".  

Of course the real starting place is to make sure your diagnosis is accurate.  As a rough cross check against the current diagnostic approach, which looks on the basis of the medications and your story to be "bipolar disorder", you can take the Mood Disorders Questionnaire.  If you have a strong "yes", you can take the results with you to Iowa City and that might help (both to make sure that bipolar disorder is considered, and perhaps to speed things up a bit, although when you're having a re-analysis like this you wouldn't want them to just hurry along and assume the bipolar diagnosis is correct.  The point of the test would be to protect you against the possibility of getting interviewed there by a doctor who's not particularly inclined to diagnose bipolar disorder.  If that happened, and you have a strongly "yes" MDQ, it would be harder for them to proceed and discount the bipolar-like qualities of your mood experience.)

Beyond that you can find most of my thoughts about treatment options in the treatment section of my website on bipolar II; anything new that emerges, such as something I learned today about PCOS and bipolar disorder, which may be pretty darned important for some women, will be listed under "what's new" on the home page, so you can check back there periodically.

 Dr. Phelps