Celexa, Geodon-Right for Me?
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Q:  Celexa, Geodon-Right for Me?

I have recently been diagnosed as probably having bipolar II.  I have been reading everything I can on the subject and am fairly well convinced this diagnosis is correct.  I have always been unable to control my moods and had worsening cycles of deep depressions alternating with times of dealing just fine in the same circumstances.  I also have serious problems with anxiety and insomnia and have been on every different antidepressant out there to varying degrees of success.  Trouble is, they all stop working after awhile.  My question is this, while recently being hospitalized, my doctor changed my medication to Celexa and Ziprasidone (Geodon).  I can't find anything regarding the mood stabilizing properties of Geodon on the net or at the library and want to know more about it.  Is it the right approach for me?  It is helping significantly, but it is putting me to sleeep constantly.  And with all that I'm hearing about the dangers of antidepressants, is the Celexa a problem?  He just had me cold-turkey quit the prozac and I'm concerned about that too after what I've read.  Please help.  Especially about the Geodon.  I can't find anything.

Dear Amy -- 
Let's see if I can keep my well-traveled knee from jerking at some of the things you've written.  You see, one of my frequent frustrations is seeing people put on antipsychotics without decent trials of mood stabilizers -- especially when they have BPII.  However, in your circumstances your doc' may really know what he's doing.  For example, switching from Prozac straight over to Celexa is not as much of a problem as it sounds, because the two are very similar and in unipolar depression a common way to get from one to the other is just to switch right over. 

Similarly, your doc' seems to be trying to control the whole picture, not just the depression, and that's good too.  If you haven't had trials of "mood stabilizers", you might want to gently advocate for going that way next and trying to taper the antidepressant.  You've probably already read my opinions about treatment (see "treatment" under BPII), including using other mood stabilizers than lithium and Depakote (see "treatment details").  Your doc' may have picked Geodon trying to avoid the weight gain commonly associated with Zyprexa, a new generation antipsychotic that clearly has "mood stabilizing" properties -- he may be trying to get the same effect from Geodon (only problem is, it's too new to know for sure if it really does that; I've not prescribed it for one patient yet, except when someone else started it, because I like to wait and see what the side effects look like after people have been using it for a year or so in big numbers).  

So in general it sounds like you might be headed in the right direction.  I hope you keep up with your education and are able to help your doctor with some of the decision-making as a result. 

Dr. Phelps

Published September, 2001


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