Q:  Neurologist and/or Psychiatrist ?

A neurologist diagnosed me with bipolar disorder three years ago.  I have been on effexor and topomax for the last 2 1/2 years.  Although my disorder is not severe  I still wonder whether I am getting the treatment I need.  Can a neurologist really be the right person to treat me?  I asked whether I need to see a psychiatrist and he said that I didn't. I also do not feel that the medication is doing much for me.  I am lethargic and have no desire to go anywhere.  The doctor told me I just needed to lose weight.  I am 5'1" and 213lbs.  I know am overweight, but I have seen many happy big people and many screwed up thin people.  Help me.  Do I need to see some one else and could I be on the wrong medicine?

Dear Ms. R' -- 
Perhaps in the system of health care that you deal with, you are not free to seek out a psychiatric opinion?  (not available, need referral, can't afford, something like that?)  Because it certainly sounds like you'd like such an opinion.  If you've read about bipolar treatment (e.g. on my website, the Treatment section of the Bipolar II material), you know that your current medications are not the routine approach to bipolar disorder, although there may have been good reasons for selecting them for you that I am not aware of.   

However, to put it more simply, I could say that yes you might benefit from an additional opinion.  But that isn't saying much, because so might most people with complex symptoms or not-improving symptoms.  Here are some thoughts about weight and bipolar treatments, as that may become an issue as well.  

Dr. Phelps 
 

Published December, 2003