Dear Dr. Gorman,

I was diagnosed as Bipolar type 1 with psychotic symptoms in 1992. I've never achieved my own normalcy with any medication, that is until I found Geodon. A doctor gave it to me in August 2007, and it was like the magic bullet, it destroyed all my depression and anxiety. I could laugh and smile and be in public without caring what others thought. I no longer took things so personally. My anger was suddenly in check. I felt like this tremendous weight had been lifted from me. I literally felt physically lighter. Basically, I felt like myself.

The administration of the Geodon went like this: 20 mg for three days, 40 mg for three days, 80 mg for three days, up to 120 mg. When the doctor saw how well I was doing, he increased the dosage to 160 mg, and finally up to 200 mg. By that point I had no feeling, my emotions were blunted, it was like walking in a daze. All the wonderful effects were gone. The doctor had me go back to 120 mg a day, but I still felt bad. I even stopped the medication altogether for a few days, and then went back on it, expecting the normalcy to return. It didn't. Since then, I've tried Geodon once more, but all it does is make tired.

What happened? I had three weeks of wonderful, and then it was snatched from me. Why did the Geodon quit working? Can you explain it? No one else can.

I know this is probably not the kind of question to ask of an Internet "Ask a Psychiatrist" Web site. I realize the site is likely meant for more general questions that could be applied to several people. But I am at my wit's end. I want to know why the only medication that ever really helped me suddenly conked out after three weeks. I have been on Wellbutrin for years, and while it's not perfect it never just quit working.

If you do have an answer, I would love to hear it. If it helps any, I am a 27 y/o female, low body weight, at the time of the Geodon I was also taking 300 mg a day of Wellbutrin XL and 450 mg a day of Eskalith lithium.

If you have no answer, I understand. Like I said, no one has an answer.

Thanks.

--J

That is a very difficult question. There have been articles written about the loss of effect of certain medications once they are stopped, and then a relapse occurs. Increasing the dose rarely produces what you have experienced, as lowering the dose subsequently usually works.

Take the following remarks with a grain of salt as you may have already tried them. The closest medication to Geodon is probably Abilify, and it is rarely sedating above 15 mg. daily. Another option is to stop the Welbutrin as all anti-depressants have the potential to induce mania, mixed states and even depression. My favorite medications are Lithium, Lamictal and the atypical anti-psychotic medications: Zyprexa (weight concern); Risperdal (sedation, neurological side effects); Seroquel (sedation); Geodon (sometimes ineffective); Abilify (sometimes ineffective). Another medication that can help with depressive symptoms is Mirapex.

Always consider looking at lifestyle adjustments or talking therapy to see if there are underlying issues promoting the depression. At the end of the day, speak to your doctor as they know you best. Don't hesitate to keep trying things as you were well once and it should be achieved again.

Good luck, I hope this helps and take care.