Q. My son-in-law to be, has  Bipolar Disorder 1. He has had two psychotic episodes. One episode was at the age of 19, one just last March when he was 27. At the time of his second episode he was maintained on proper doses of lithium, and was also taking Zoloft, but I don't know the dose. He broke through his medication and lost nearly all touch with reality for about 4 weeks and was hospitalized. 

The points of my inquiry are several fold. He is currently in a functioning, but in miserable depression. The Psychiatrist has him on Depakote and Lithium, but his mother, who also has the bipolar disorder insisted to his Dr. that he not be given any antidepressant as she was certain that that is what caused his last psychosis. Did it? Do they? My feeling is No. (I am cyclothymiacs and am on antidepressants with positive results). Is it possible, when someone with bipolar disroder is depressed, to go into a psychotic state? My daughter, who loves and will marry him, is anxious to know what symptoms herald an episode.

  A. Many good questions and no clear answers. I cannot tell what his diagnosis might be, so that he could have something that looks like bipolar I, but is not. Second, the question of whether antidepressants cause psychosis, or rapid cycling for that matter, is still up in the air. It becomes a question of what is best for the patient, since there is little data to support antidepressants causing mania or psychosis. Interestingly, almost all of the anticonvulsants used to treat bipolars cause depression, but no one seems to care about this.