GENERAL TREATMENT NOTES

There have been major advancements in treatments for both depression and bipolar disorder (or manic depression) in the past twenty years. Before your mental health care professional prescribes medication for you, he or she should make sure that your condition is not associated with any other medical problems. Once your doctor decides that you are a good candidate for a medication regimen, they should explain how the medication will work and the possible side effects you may encounter. This is the time to inquire about the medications that your doctor is prescribing -- don't be afraid to ask questions about your treatment.

Usually, if you are diagnosed with depression, your doctor will prescribe a serotonin reuptake inhibitor (SRI). Today, most people are familiar with the most popular of this family of the "designer" drugs -- Prozac (its chemical name is fluoxetine). Prozac has been heralded as an "emotional Band-Aid" and cure-all for depression, but you might also be treated with Zoloft, Effexor, Paxilor, Wellbutrin, or Serzone. The problem with some of these drugs is that when they are used to combat depression in the case of a bipolar patient, it can induce mania and rapid cycling. For me, taking Prozac fueled my mania and put me into very dangerous situations. For the most severe cases of depression, MAOIs (monoamine oxidase inhibitors) are used -- these are the strongest antidepressants available. Finally, you should be aware that your medication may have side effects including drowsiness, weight gain, dry mouth and constipation. These medications may also interfere with your sex drive.

Luckily most bipolar patients respond well to lithium, and need only to take this one medication to control their illness. For the others who have no success with lithium, there are other mood stabilizing medications, primarily Depakote (its chemical name is divalproex sodium), which is used to control mania (it is also used for seizures). In conjunction with lithium, it usually stabilizes the bipolar patient. Other medications that can be used in conjunction with lithium are Neurontin, Tegretol, Klonopin and Lamictal.

Bipolar patients who require anti-psychotic medication can also be treated with Risperdal, Zyprexa, Haldol or Seroquel. With some of these medications there are several risks:

* Tardive Dyskinesia (TD) may appear with use after extended periods on the older anti-psychotics. The patient has uncontrollable movements and spasms of the tongue, head, neck and even limbs.

* Parkinsonian Syndrome may occur and the patient may experience hand tremors and muscle stiffness in the face and rigidity in the arms and legs. There are medications to counter this side effect including Cogentin, Symmetrel and Artane.

* Akathisia is a symptom that causes the patient to be edgy and irritable and it stems from the anti-psychotic. It can be treated with propranolol (which is also used for tremors) or Valium.

It is important to remember that drug therapy may be complicated by alcohol or substance abuse and the patient must closely monitor his habits and avoid self-medicating.

There are those patients, both unipolar and bipolar, who do not respond to any type or combination of medication. Sometimes they spend years experimenting with all kinds of medication, searching for the "cocktail" that will cure them. Ultimately, their situation gets so severe (sometimes they even become suicidal) that they are forced to opt for the last resort -- electroshock therapy. It is interesting to note that some doctors choose ECT over a medication regimen because they believe it is quicker and more effective.

Finally, pharmaceuticals alone are not enough. Psychotherapy, in addition to a well monitored regimen of medication, helps the patient to understand his or her illness and learn to live a fulfilling life with a mental illness.