Dr ivan's question and answer
page one
Q.  My fiance' has been taking the usual prescribed drugs for Bipolar Disorder.  We recenttly saw a TV program about Margot Kidder (the actress) who also has Bipolar. 
In the show she mentioned that she hd Bipolar and had been taking drugs and was fed up taking them.  She now and continues to be treated with acupuncture and feels she has the problem under control.
Can you give us any advice concerning this treatment and how can we contact the person performing the treatment.

A.         There are no studies that have demonstrated that acupuncture is an effective treatment for people with Bipolar Disorder.


Q:  i am bipolar and add... my previous Dr. would not prescibe ritalin so i changed doctors and am now taking 10 mg a day once in the morning and should take another in the afternoon but don't...i am not sure this ritalin is working as it makes me a little nuts i am experiencing mood swings and deppresion but am also taking wellbutrin and depakote.. my life is spiraling downward(again) i am ready for everything to be  working harmoniously but my medicine never seems to be right...please  help!!!  should i be on ritalin from your perspective or is it the other drugs? i want off depakote - i am getting FAT!!!
any knowledge of topomax? sorry this is so lengthy.....thank you very much!!

A:       Many people seem to have both ADD and Bipolar Disorder.  In some instances they actually have both disorders and in some instances the Bipolar Disorder causes symptoms that looks like ADD, and in yet others the ADD causes mood swings that are mistakenly diagnosed as Bipolar Disorder.  Only a psychiatrist with a good deal of experience in dealing with ADD and Bipolar Disorder can make an accurate diagnosis.
Topamax (topiramate) is turning out to be a very useful medication,
         especially for people whose Bipolar Disorder is hard to treat.
         For information on topiramate please see:




Q:  My friend, Neil, is incarcerated in prison.  He planned and carried out
a murder.  Family and friends have reckoned for some time that he is
bipolar but as yet he is undiagnosed. He has answered yes to all the
questions in a questionaire to indicate bipolar. He is now open to the
idea. How often do bipolars commit murder and would he have been manic
when he did it?

A:        I am unaware of good data as to the frequency that people with
         Bipolar Disorder commit homicide.  If you remember that mania
         causes irritability, impulsivity, and impaired judgement, it is not hard
         to understand how people in a manic state may commit criminal acts.


Q:    My diagnosis was about 2 1/2 years ago as bipolar, but I do not fit
neatly into any category. I have been hospitalized Oct 97 with a severe
low but have only briefly experienced the highs where I felt like I was
drunk. There was an edge to the laughter which ended up in sobs within
hours. My highs are mostly the racing thoughts and extreme irritability
to the thought of violence against the offending parties. (which I  have
never acted on). Currently I am on no meds but there is the continual
sleep disturbances waking in the night, waking up tired. Lack of sex
drive, overeating, hermitlike social life, unable to deal with stress.
All of these are low grade but the quality of life is down. Is there any
hope? I have been on almost all meds in the last 8 to 10 years. Some
worked for a time, changes were made in dosages. But I am frustrated is
it chemical or is my thinking so negative now ? Please help if you can.

A:         Many people suffer with chronic depression sometimes together
         with racing thoughts and other hypomanic symptoms.  People with
         such mixed states often do best when treated with Lamictal and/or


My spouse was diagnosed with bi-polar disorder about 1 1/2 years ago. 
He has been on Risperdal (1.5 MG)a day.

He was an avid kayaker, jogger, and skier. He has responded well to the
meds, but has no desire to do any of these sports, nor anything else. He
has gained over 20 pounds.  He is only 5'4" and weighs over 150!!  I've
noticed that he has low self-esteem and absolutely no desire and energy
to even try to get back into shape.  Is this normal?  I agree with him
that his personality is totally opposite now.  When he comes home from
work, he eats dinner, then heads to the couch and crashes every night! 
Should he be on something else besides Risperdal?

        A:    I prefer not to use antipsychotic agents such as Risperdal to
         treat people with Bipolar Disorder because of the possibility of
         tardive dyskinesia.  It sounds as if your husband is depressed and
         should be evaluated for possible treatment with the combination of
         a mood stabilizer + an antidepressant.


Q:  Good Day Dr.Ivan, My question may be a little strange, however I am
curoius if you heve heard of Flexyx Neurofeedback System. I understand
it is fairly new. I stumbled across it through a fibromalygia
diagnosis,I am also Bi-Polar and some of the findings seem to indicate
it may help with both. Please advise of your feelings about this new
process. They have a web site at www.flexyx.com if you have any
questions. I am strongly considering this. Please help me with your
opinion.Thank You,Thank You Donna

         A:  Please ask for reprints of studies from peer-reviewed journals
         that show that the technique was demonstrated to be effective
         in double-blind placebo-controlled studies.  I will bet that there
         are no such studies.


My question is not specifically about manic-depression, but about mental
illness in general. I'm doing a research project on the causes of mental
illness in which I am arguing 3 sides: 1)Mental illness is caused by
purely biological factors.
        2)Mental illness is caused by purely environmental factors.
        3)Mental illness is caused by a combination of both biological
and environmental factors.
I believe the third theory, but I'd love to hear your take on the issue.
I'm not a professional, just an aspiring psychologist who happens to
have Bipolar Disorder and would like to know why. Thank you for your

         A:  If you are speaking in the most general sense the third possibility
         is correct, but for individuals there are some people in whom their
         problem has its roots 100% in biology or 100% in the environment.


Q:  Hi Dr Ivan

The doctor that I am a partial at just suggested ECT to me. What do you
think of this treatment.


         A:  If I had a severe depression that did not respond to drug therapy
         following 16-weeks of drug therapy, I'd want ECT.

         For information on ECT please see:



Q:  I am 44 years old.I was diagosed with manic depression two years ago. I take 2700 mg of neurontin, 20 mg of celexa, and 10 mg of aricept daily.
I am considered to be a rapid cycler. I was first prescribed depakote,
but I had a horrible reaction to it. I am better on the neurontin but
far from perfect. Do you feel that there might be a better choice of
medication for me. 

         A:  Topamax and Lamictal should be considered.


I know that you undoubtedly have many things occupying your time, so I
am asking my question again.
   I have been diagnosed Bipolar II but during manic episodes,I begin to
hear voices, sometimes indistinguishable, sometimes very clear,
sometimes loud, sometimes softer. Sometimes for the entire manic period
and sometimes not.  I have asked others in your field why this occurs,
and the answer I receive is "The disorder is just like that".  I have
consulted numerous publications and other websites and none has provided
an answer.  I would ask you, Why? Is this something to be concerned
about? I thought that "voices" were indicative of Schizophrenia, is
this true?

Thanks for your help,
      Dan C.

         A:  There is a psychotic subtype of Bipolar Disorder in which hallucinations
         and delusions may be found.  The mechanism by which these symptoms
         are formed is not known.  The prognosis for people with the psychotic
         form of Bipolar Disorder is MUCH better than the prognosis for people
         with Schizophrenia.

Q.  Dear Dr. Ivan,

  I have tried to e-mail you in the past, but I may have been somewhat incoherent at the time, so I
  thought I would try again. I have been diagnosed with bipolar 1, rapid cycling and have been
  cycling for over 2 years (hypo/manic/mixed lasting about 1-3 weeks, depressions a month). I
  have been on depakote, tegretol, lamictal, and combinations; about a dozen AD's, klonopin,
  ativan, zyprexa, risperdal and seroquel. My pdoc of 2 years felt he could no longer help me, and
  I went through several more pdocs with a recent hospitalization for an overdose that was judged
  to be suicidal but I felt happened because I just couldn't stop my agitation- both physical and
  mental. I got Dr. Akiskal's name from your site, however he no longer accepts patients. I have
  abused drugs in the past, but no longer do so. I have no psychiatrist at present and am taking
  6mgs of klonopin a day because that (and risperdal) has been one of the only drugs that makes
  me feel better. My internist is willing to give me medications, although he is pushing me to go to a
  psychiatrist. If you have any names to suggest (I live in San Diego), or a course of action to take,
  I would greatly appreciate it. I was a scientist (cancer research) but am no longer functioning
  very well. I am 40, married and have a child. Sorry for the length of this post and thank you for
  your time.

A.        I think that anyone with a complex history such
        as yours should be treated by a psychiatrist
        who is familiar with the treatment of individuals
        with Bipolar Disorder.

        You might ask Sidney Zisook MD (619-497-6618 to
        help you find a psychiatrist with more than 
        average skill in treating people with Bipolar 


 Q:  My son has been on Tegretol and Seroquel for a year and a half.  I feel OK about
  the Tegretol, as in the past it has been a good stabalizer. Isn't Seroquel a neuroleptic?  My
  understanding is that it is used to bring the mania down.  He wants to decrease the dosage and
  no one seems interested, or they are afraid.

  He was medivac'ed from the Tongan Islands in summer of 1998, entering Queens Hospital in
  Honolulu with neuroleptic malignant syndrome, had been totally delirious from high doses of
  Haldol in Tonga and was given massive doses of Thorazine on the flight to Hawaii.  Thereafter,
  he had tons of ECT sessions and was started on the Tegretol and the Seroquel.  He is in a group
  home now and is really normal, miraculously.  So my question is about the Seroquel.  Is it
  normally used long term??

A:    Long term antipsychotic medication is occasionally
        necessary to help some people with Bipolar Disorder
        remain euthymic.  Unfortunately, many psychiatrists
        after using antipsychotic medications to treat
        acute manic or depressive psychoses are reluctant 
        to discontinue these medications when the psychosis
        has remitted.  This unfortunate practice exposes
        patients who are so treated to the possibility of
        developing tardive dyskinesia.


Q:  Hello Dr. Ivan,
  I have been on medication for bipolar affective disorder since 1980. I'm now 44 yrs. old and it
  seems to me as I've gotten older I have required more meds and different kinds. I'm on  350mg.
  of Wellbutrin, 1200 mg of lithium, 30mg of buspar and 3.75 mg of clorazepate T.I.D. I almost
  forgot I also take Levoxyl and Volterin.  I feel like death most of the time and have talked this
  over with my Dr. many many times but  she seem to think I need all this junk.  It's very hard on
  me to hold down a job. I've tried and have done it for years but I can't do it anymore.  I told her
  this  and she said I was too high funtioning to get disability.  That's because I have always pushed
  myself to work but as I have gotten older I have found I have sooo much problems with my
  memory and stress with driving, people at work and the job it self.  Please can you help me???
  Thanks so much for your time and I really do appreciate any help you can give.  I've even tried
  to go to college but had to stop-stress!!!  Everything I try doesn't seem to last long. I do have a
  wonderful husband but sometimes I feel he is sick of me being sick though and I don't blame him.
  Sincerely, LaDawn

A:        I think it may be time for you to have a 
        consultation with a psychiatrist who is
        expert in the treatment of individuals with
        Bipolar Disorder.  A list of such psychiatrists
        may be found at:


 Q:   I read on a bipolar sight that tenuate not tenuate dospan is a reasonable drug to
  combat the weight gain that one has gained through the use of the polypharmacy over the years.
  Could I be
  reasonably certain that it is safe for me? Joyce

A:        There is little evidence that Tenuate or any other
        "diet pill" will cause sustained weight loss.
        Many psychiatrists are now prescribing Topamax
        for people with Bipolar Disorder who have gained
        a significant amount of weight from previous
        treatment with mood stabilizers.  Topamax is the
        first mood stabilizer that regularly causes weight

        For information on Topamax please see:



 Q: What is your opinion of the prevalence of high IQ and creativity accompanying
  bipolar disease?

  Does it seem as though the bipolar symptoms lessen (especially if the depression is treated)
  sometime in the 40's?  Do you think that people have just learned to handle it better by then? 

  Do bipolar people get divorced more than other people?

A:        While some people with Bipolar Disorder note a
        reduction in the frequency and/or severity of their
        episodes as they get older, this does not happen 
        to everyone with the disorder.

        Divorce is unfortunately common for people with
        Bipolar Disorder.


Q:   I've lost my kids,my relationship with my husband is falling apart and so am I every
  time they put me on a new med the side affects are too much,mostly headaches wich I'm prone
  to anyway I want to disapear its been 2 yrs since I was diagnosed and I've tried all meds Im at
  my wits end I've overdosed a number of times and now I want to make it permanent! I need to
  know if there is any hope left? PLEASE RESPOND IM IN TROUBLE AND I KNOW IT.I

A:        Many people have the impression that they have
        tried all the available treatments for their
        Bipolar Disorder and that nothing works for them.
        Complex combinations of thyroid and multiple
        mood stabilizers (such as Lamictal + Topamax) have
        helped many people whose Bipolar Disorder has 
        previously been impossible to control.


  Hello Dr. Ivan,

  Nine years ago I was diagnosed with Bipolar I, and now take Lithium, Prozac and Tegretol
  (Carbamezapine) to treat it. My question concerns the quality of life I might expect while living
  with this disorder, as well as my expected longevity. I graduate at the end of Winter 2000
  quarter with a B.A. degree in Computer Information Systems, which would be very encouraging
  if not for the problems I have socially. Will I end up working at the gas station? Who can say.
  But I would be interested in knowing how others with this disability have fared.

  Thank you for any information you can give me,


        Individuals with Bipolar Disorder have held
        responsible jobs including President of the 
        USA.  With today's treatments more and more 
        people with this illness can look forward to 
        a long productive life.


Q:  How can I get rid of the 50 pounds thatI have gained since going on depakote,escalith ,zxprexa(
  which I am now off),synthroid and effexor?  Please help.  I no longer have a figure and I can't
  find any clothes to wear,

A:        The combination of a severe calorie restricted
        diet + exercise helps people lose weight. 
        Switching to Topamax as a mood stabilizer makes 
        the weight loss process easier as Topamax reduces 


  Dear Dr. Ivan, 
  Thank you for your responses to my earlier questions!! I have some more..
  What dosage of depakote is considered to be a maximum daily dose for a 12 yo 5' 6" 130lb
  child?  My daughter takes 1,125mg/day of depakote (no other meds) for bp.  Is this a lot? It
  does seem to work well but she's gained weight & I wonder if neurontin or a newer drug with
  fewer side effects should be tried.

  The bp kids I know are somewhat immature (emotionally) and have difficulty accepting
  responsibility, making good choices, etc. Is this a product of the bp?  How can I as a parent best
  help in this area?  It is hard to tell what behaviors to attribute to bp and what is stubborness,
  hormonal, immaturity, defiance, etc. I want to be fair and have reasonable expectations!

A:        Depakote is one of the medications that is
        regulated on the basis of blood tests.  There 
        is no such thing as a maximum dose . . . the right
        dose is the one that results in a blood level
        that successfully control the symptoms of the 

        As for the matter of behaviors.  Children with
        Bipolar Disorder need structure and help main-
        taining routines.  They also frequently need psycho-
        therapy to help them repair their self-esteem that
        was damaged by the experience of being ill.


Q:  I am a manic deppressive bipolar,i have started a new drug called LAMICTAL it is a mood
  stablizer as well as antideprresant, It has done wonders for me. 10 years of searching for the
  proper medication ,is hell on earth,finally im stable life does have normality after all ,also been in
  psychotherapy 7 years that part goes hand in hand .
  Have you heard of this new drug? If so what is your advise about it

  Thankyou Susan B

A:        Lamictal is an important addition to the mood
        stabilizers that are available.  It has helped 
        many people who have not responded to other
        mood stabilizers.  For information in lamictal,
        please see:



  I have been diagnosed with bi-polar disorder from the age of 18.  I have a niece and nephew.  I
  got my disorder from my father who got it from his Aunt.  My question is:  Will my niece and/or
  nephew have a chance of contacting this bi-polar disorder?

A:        Your niece and nephew have a greater chance of
        developing Bipolar Disorder than people from 
        families in which there are no people with
        Bipolar Disorder.


 Q:   My 12 (soon to be 13) year old daughter was diagnosed in Nov 99 as bipolar
  following a suicide attempt (she scratched her wrists with a screwdriver).  Her mother and I are
  divorced and this attempt could possibly have come from her being upset about that.

  After reading signs and symptoms of bipolar, I do not see these signs in my daughter.  Is there a
  reliable source on the internet that discusses onset in teenage girls?  She is currently being
  followed by mental health professionals and is on medication.  I am just interested in finding out
  more info before I speak with the professionals so i can ask intelligent questions.  My daughter
  has had no other manic or depressive episodes either before Nov 99 or since.



        For information in Bipolar Disorder in children
        and adolescents, please see:


 Q:  Where can I find research on bipolar and children?

  A:  See question above.


Q:   Is it true that bipolars are more prone to problems with their blood sugar?
  If so what kind of diet is advisable to combat this?


A:        Unless an individual has abnormal blood tests
        indicating difficulties with sugar metabolism, 
        there is no need for a special diet.


Q:  I was told it might be bipolar cause i get this feeling of emptiness and cry at all times
  for no reason and also i get angry and upset at times i can be fine one minute the next i am a
  basket case i have been on Zoloft Serzone and now Wellbutrin plus lorazapam and Ambien to
  try to sleep and none of these meds work and lately i been feeling like life aint worth it anymore

A:    People who have symptoms of depression, and who 
        do not do well when treated with antidepressants,
        very well may have Bipolar Disorder.  They should
        seek out a psychiatrist especially  experienced 
        in the diagnosis and treatment of people with mood


Q:  Dear Dr. Ivan,
How does PTSD affect Bipolar and vice versa? Thank you, John

A:  PTSD is an anxiety disorder and while people with PTSD may be depressed they always show certain symptoms.  These symptoms include reexperiencing their old trauma either in dreams or when awake, attempts to avoid reminders of the old trauma, and often feelings of being unsafe, even where there   is no real external danger. 
Bipolar Disorder is not a form of PTSD, although the two disorders can coexist.  When an individual suffers from both PTSD and Bipolar Disorder, there is a high probability that they will be misdiagnosed as suffering from Borderline Personality Disorder.

        Please see: 
        for information on a medication that can be used to
        treat both PTSD and Bipolar Disorder.

  Q:  I have suffered severe physical/mental abuse and believe I suffer the symptoms of being Manic.  I was taken to a few doctors when young, but not told anything.  It's getting hard to hide this from friends and family I feel like I might go into a depressive state and not come out as I usually do.  Please, anything you can
  suggest. I don't want to be medicated, but need help. Thanks

A:  From the information you provide it is impossible for me to determine what is the problem, and what  might be done to help you cope.  It sounds as if you need a full evaluation to determine exactly what is going on.  If you need help finding some-one to do such an evaluation, a list of expert psychiatrists may be found at:


Q:  Dr. Ivan, my 12 yo daughter is bp.  She is on 1,000mg of depakote daily and she also takes 500mg of tetracycline/day.  Do they interfere with each other's effectiveness? 

A:  I am not aware of an interaction between Depakote and tetracycline.

Q.  Also, sometimes I can't tell if her irritability is from mania or depression.  Is this common?  What would you suggest? 

A.  Irritability is a very nonspecific symptom.  People who are both manic and depressed may be irritable.  Irritability may also be seen in some people who are in physical pain or who are suffering from any sort of emotional distress.

Q:  Do you feel that lead paint exposure could bring on bp?

A:  Lead poisoning may cause psychiatric symptoms which at times might mimic Bipolar Disorder.  If lead exposure is suspected there is a  simple test for lead poisoning.

Q:   Do you foresee some of the newer anticonvulsants being able to be subscribed soon for bp?  Why can't they be used now?

A:    Many psychopharmacologists are currently prescribing Lamictal, Neurontin, and Topamax for people with Bipolar Disorder.

Please see:




Q:  I'm placing a lot of hope in the future "cure" for bp with human gnome experiments.  Do you see that as our best possible treatment or if not, what else is on the horizon?

A:  I agree that gene therapy is the best chance for a true "cure" for people with Bipolar Disorder.  I think the continuing development of psychopharmacologic treatments will provide more and more people with a good means of controlling the disorder until a "cure' is developed.

Q:  When a young person (pre-teen) is diagnosed bp does this usually mean that his/her illness is more pronounced?  In other words, does age of onset equate with degree of severity?  Thank

A:  A number of studies have shown that the long-term outcome is no worse for people whose Bipolar Disorder started in the teens when compared to individuals whose disorder started later in life.

Dear Colleen & Dr. Ivan,

  Thank you again for providing this service!  I have some more questions......

Q:  Do you feel that bipolar is a condition of mini brain seizures?  Is this a new theory?

A:  It has been proposed that seizure-like activity deep in the brain plays some role in causing Bipolar Disorder.  There is little evidence to support this theory.

Q:  Since the frontal brain seems to be the area that provides judgement skills, morality, inhibits impulsivity, etc. what studies are being done in this area for bipolar affected persons?  Would you recommend an EEG be done on your child if you had a 12 yo with bp to determine if this area of the brain is understimulated?  How could these tests be useful to a parent?  How can a parent help to increase stimulation of her child's frontal brain area?

A:  It is not clear that the impulsivity and lack of judgment that often accompanies mania are specifically related to frontal lobe problems. An EEG contributes little to the diagnosis and treatment of individuals with Bipolar Disorder.