I'm taking Neurontin 3x a day (total of 1200 mg) and 25 mg of Celexa at night. Continue to have racing thoughts--although the 2 drugs have increased by quality of life MUCH, as I was only recently diagnosed (my dad is bipolar too). I've tried Depakote--no luck--I felt more manic.  My physician prescribed Seroquel (25 mg to start). Like others, I didn't want to take an antipsychotic as I've not had psychoses and for the "stigma"--but after reading about Seroquel I've decided to try it.

My physician says I can continue the Neurontin and the Celexa--that I may be able to do w/out the Celexa & the Neurontin if Seroquel works.  My question is: Seroquel has been successful for bipolar patients taken in conjunction w/mood stabilizers. I'm taking Neurontin for a mood stabilizer, but it's really an anti-seizure drug. Do you agree that it's ok for me to take the Seroquel & the Neurontin together? (My physician says ok to experiment with the 3 drugs as long as I don't increase dosage)

Thanks--Jackie
 

Dear Jackie -- 
If your diagnosis is bipolar and it's accurate, then you're not really on a well-documented treatment even now, let alone with the Seroquel (we'll get to that in a minute), BUT, you're doing much better than you were so now you may be in a position to work your way along slowly.  Adding Seroquel might indeed help decrease cycling.  I've seen it at least help people sleep who were having terrible insomnia and not responding to our usual approaches for that.  However, we have the least data on that new-generation antipsychotic, compared to Zyprexa and Risperidone.  So if you're coming around to a willingness to try things like this, and if you were really asking to go by "data", then you'd have to consider these others first.  But again, you sound like you're comfortable with the doctor and her/his approach, and that's very important.  It also sounds like she/he can collaborate with you finding your way along, and that's good too.  

From there, you could read more about my particular views on mood stabilizers, where you'll see I'm not a big Neurontin fan and cite some data accordingly.  Similarly you can read my views on antidepressants, which might be relevant because you're still cycling and still not technically on any mood stabilizer.  

But, again I emphasize that you're better and so you don't have to be strictly following any particular rules or guidelines unless you get to the point where you and your doctor are feeling lost -- that's when I turn back to the main principles that usually seem to lead me in the right direction:  rely on mood stabilizers, watch out for antidepressants.   Good luck to you. 

Dr. Phelps 

Published December, 2002