bipolar disorder, Dr. Paul Markovitz  Q. I am writing about my 9 year old son. He was dx with a learning disorder at age 7 with attention disorder. He has now been dx as bp2, after many trials and errors on meds for attention. After going to a psychiatrist he was put on Litho bid 300 mg bid, Paxil10mg,qd, and Adderoll 10mg q am. He did great for a while and then went down very rapidly. Come to find out his Litho bid level was o.6 because he was not really taking his am dose. His Dr. took him off of the Paxil because it can cause manic in bipolar. I've noticed he is more apprehensive and less social. What is the news about Paxil and related drugs to the bipolar? I've read a lot of letters with pt. on Paxil or Prozac. Please explain, and with Serzone.

  A. It sounds like a complicated case, and I do not have enough data to do you or your son justice. To the best of my knowledge, Paxil does not cause rapid cycling anymore than one would get taking placebo. Albeit there have been no studies that I know of with Paxil, there are with other SSRI. Studies with Prozac in BPIIs (Johns Hopkins) and Zoloft (U Penn) showed they actually help a good deal in adults, and do not cause mood swings to increase anymore than folks taking placebo.

I would ask your doctor what the game plan is that he is following and see how it works. If you have concerns, discuss these with him. Most doctors do not mind delineating their ideas on treatment, and why they are doing what they are doing. As a last resort, I tell my own patients, if you lose faith, get another opinion. The medications used to date sound very reasonable.