Always start with lithium or Depakote
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Always start with lithium or Depakote?

Q: My 30 year old son has been abusing drugs and alcohol for the past 15 years. This began at the time of divorce. Since then he has done a lot of crazy things and been in a lot of trouble with the law. But three mos. ago quit drinking and went to halfway house but left too soon. Has just been diagnosed as bipolar as his sister was just 3 mos. ago (I wrote you 2 wks. ago). Anyway, even though he told the Dr. that Depakote did not help her (is finally getting better with Tompomax and Neurontin)he insisted he has to start with that - even tho he does not have insurance, a job or any money. Do you always have to start with Lithium or Depakote? Do you know where he could get assistance. The county he is in only helps with Psy. visits. No medical. Thanks again.

Dear LaVerne --
When someone in a family has no response to Depakote, and a good response to topiramate, I think most psychiatrists would strongly consider starting with topiramate instead of the usual reliance on "the big two" as a starting place.  As for getting assistance, I'm sorry I can't figure out the structure of the medical system in his area -- it's hard enough keeping track of how we're supposed to do things where I am.  Maybe the local county mental health folks could at least take a stab at your question, or try asking on some bipolar bulletin boards (about.com has a huge one, and of course there's right here on Bipolar World).

Dr. Phelps


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