I have tried all of the atypical antipsychotics and I am not able to take any of  them because of various reasons. Ie: Zyprexa makes me morbidly obese, I get the  hives and a rash with Geodon, I get high prolactin with Risperdal and so on all the way down the list. What options do I have for living with bipolar and the  psychotic symptoms? I'm on my second try of Abilify and it's my last shot at an atypical antipsychotic. Abilify makes me very anxious and I feel a lot of dread and I can't it really affects my driving. Please help.

Thank you.


Dear Needs --

I am sorry to hear about this -- for two reasons. First, you are obviously concerned about running out of options.

However, the second reason is a bigger one -- but good news for you! Perhaps you have already tried other "mood stabilizers", but the phrasing of your question strongly suggests that so far for you were presumed bipolar disorder, you have had only the atypical antipsychotics as treatments. If that is true, the good news is that there are several other options, several of which are among our best treatment options. Go read about mood stabilizers on my list of all the mood stabilizer options (sorted by evidence for effectiveness).

The reason for my second concern is that I really worry people are beginning to think that atypical antipsychotics are all mood stabilizers (some are, some are doubtful in that role, and at least one -- ziprasidone -- is probably not). Worse yet, some people may also think that all mood stabilizers are atypical antipsychotics, which misses out on at least two if not four of our very best options. For example, if my second concern applies to you (not your fault; somehow an impression you were given), then you are going to be learning about lithium, valproate (Depakote), and possibly carbamazepine/oxcarbazepine and lamotrigine.

Good luck with your learning --

Dr. Phelps


Published December, 2007