My sister has bipolar disorder and cannot take any of the common mood stabilizers like lithium, depakote, tegretol.  She has tried lamectal and got a horrible rash.  The only thing that ever worked for her was Zyprexa.  She gained 60 lbs, however and feels miserable.  So she convinced her doctor to let her try something else.  She is now on the following meds.  Geodone - 40 mg., Topomax - 400mg.  Neurontin 900mg, Prozac, 20 mg and Effexor  300 mg.  I think she is on too much! She seems pretty drugged to me.  My question is why is she on 2 antidepressants and an atypical antipsychotic?  I know you would not recommend for her to go off anything on her own, but what do you think about this combination of meds.  What should she ask her doctor next visit.  She doesn't want to be on so many meds., but is afraid not to.  She does not feel as well as she did on ZyprexA, CELEXA and neurontin but she refuses to gain any more weight.  Thanks for your help.

Dear Emma -- 
I have a few folks on medication lists that if published here without more context would make plenty of patients and doctors go "what is he doing?!"  So I can't say from the list if that's a good idea or not, though her doctor would probably also grant that 2 antidepressants for a person with bipolar disorder is unusual.  There may be a unique justification for it in this case. 

What options exist that don't cause weight gain but have recognized mood stabilizer potential (i.e. to replace zyprexa but work like that)?  Look up verapamil; thyroid (both high-dose T4 and some very new, very limited data on medium-dose T3/T4), and a short list of others including Trileptal, which many folks can take who got side effects on Tegretol; low dose combination lithium and Depakote, low enough to stay away from side effects of either; and this lengthy list of all the more obscure options. 

Dr. Phelps


Published December, 2001