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Ask Dr. Ed Wilfong Your Own Question
Dr. Ed Wilfong
Dr. Ed Wilfong, Psychologist
Category: Mental Health
Satisfied Customers: 1528
Experience:  Twenty-five years treating all ages; Specialities: psychopharmacology & diagnosis, MMPI-2, testing.
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I have been on various antidepressants for the last 20

Customer Question

I have been on various antidepressants for the last 20 years. I saw a doctor who finally recognised that she thought i was bipolar and referred me to a psychiatrist who i have seen once and am due to see again in a weeks time. the questions she asked ticked all the boxes of bipolar except for the hypomania one, i said that i usually have a day high followed by three days low, i saw my doctor again and explained this and she looked at her notes and said what id told her previously fitted the category i just kind of forgot to tell the psychiatrist cos i was feeling anxious at the time and couldnt quite remember what it felt like when i was on a high. i am on diazepam at the moment and i also take 40mg of citalapram.i had blood tests done so she can decide what to put me on. she has given me leaflets about three drugs,lithium,valproate and olanzapine, 2 i believe are for bipolar an olanzapine is more for schizophrenics,please coul you advise me more of the effects of these drugs x
Submitted: 7 years ago.
Category: Mental Health
Expert:  Dr. Ed Wilfong replied 7 years ago.
Lithium is usually the first drug to be tried. You have to monitor the blood levels to keep in therapeutic range. All three have side effects, mostly inconvenient than harmful, so you may have to try a few. Valporiac acid is an anti-convulsive which works for unknown reasons (but we really are unsure why any of them work anyway). You are correct that olanzapine in primarily used as an antipsychotic, but it is often effective when the other meds (lithium, tegretol) are ineffective and it is sometimes combined with them.
As an aside, SSRI's celexa, fluoxentine, zoloft, etc can sometimes precipitate mania. It sounds like your depression needs treatment, but you get hypomanic and calm it down with benzodiazapines. (diazepam, temazepam, etc). I would explore the possibility of Bipolar II with your psychiatrist, which may be what s/he is thinking already. It is a form of bi-polar that does not have the extreme mania (awake and euphoric several days, high risk taking, poor judgment, lack of fatigue). Often the treatment is similar. My guess since Depression is a huge problem, the Lithium may be best bet to help. It tends to be good with both ends of mood swings, while others are more for mania. Possibly, a different class of antidepressant and a medicine to keep mania in check is possible. PLEASE KEEP IN MIND, I have not evaluated you and your psychiatrist is in best position to do so and help you select medicine. I am just trying to give you some information and ideas to keep in mind for next appointment. Good Luck.