bipolar disorder, Dr. Paul Markovitz  Q. I am a 21 year old female who has had problems with depression dating back to about 10 years old. At that time I took Tofranil until my mother decided it was unnecessary. Since the age of 19 I have taken Paxil, Zoloft, and am now taking Celexa, Cytomel, and Clonazepam. The doctor is doing blood work to check for a chemical imbalance as he feels I may be bipolar. I have most the symptoms of BPII and am wondering if this is thought to be effective treatment?

  A. BPII disorder is a number of illnesses grouped under the term BPII. Just like there is more than one kind of depression, there is more than one kind of BPII. Celexa is a good treatment if you use enough, and the type of BPII you have is amenable to this treatment. Since you have probably benefited from the Paxil and Zoloft in the past, and Celexa is in the same family of medications, it should be a good treatment. You have to take enough to get rid of carbohydrate craving, which is usually 60-80 mg/day. Hopefully, you will not need the clonazepam (which I am assuming is for anxiety) or Cytomel (antidepressant augmenter). If you are hypothyroid, you will need the Cytomel.

The previous question I answered pretty much covered these same areas. In your case (they were mostly manic), depression treatment is the primary goal. Other alternatives are Effexor, Serzone, Remeron, and maybe Wellbutrin if the anxiety you have is very low. Each of the aforementioned drugs has a different mode of action, and is worth considering if the SRIs (Prozac, Zoloft, Luvox, Paxil and Celexa) do not work.