Are there newer combinations of Bi polar medication that can address the polar spectrum and the chronic depression along with bringing back the real positive memories. of events that actually happened?

Background.. Husband of 28 years was diagnosis as a manic depression around 1986. He would have several frenzied highs of being on the go. Spending, overly boisterous, ignoring rules and authority and then become so depressed that he could not work. His enemy was always out there like work or authority. Each time it took longer for him to recover 6 months then three, 2-year cycles of depression. Overtime the treatment progressed from lithium for highs to several different anti depressants like Prozac and Paxil ect. He would always go off meds thinking he doesn’t need anything. Partly past family influence not believing in medication, mental illness and the other became surrounding family/friends that think alcohol fixes everything. This past bout of several years of work and life turmoil he was lying and did not actually take his medication for years and hit a several manic angry episode at work and then was in a severe depressive state. His memory is poor; he distorts past situations yet can pretend to be happy for others occasionally. He has become a compulsive liar paranoid believes things from the Art Bell talk show types, is dwelling on past memories that never happened. For the past 2.5 years, treated with Divalproex, Respirodone, Mirtazapine, Zopoclone, (Blood pressure 14 years) Norvasc Micardis plus. He takes some of it 60 % of the time. Omits Respirodone most of the time. Uses alcohol some days and is miserable, paranoid and of course targeting me for his miserable life. This medication combination was working for 6 months when he took it regularly and got him back to work. But his personality has changed with no moral boundaries, he is paranoid, the medication has never addressed his chronic depression although it has subsided his excessive anger at work it has brought some of it home.

I will do my best to answer this difficult query.

First, the compliance issue must be explored. Is it from the paranoia, or is it side effects from medication, or his culture of alcohol first and medication never.

Our two best medications for Bipolar depression are Lithium and Lamictal. Thyroid aways needs to be checked if someone is depressed, particularly if they take lithium. A combination of Li and lamotrigine could be the best.

For antipsychotic mediations that are tolerated well, the two best are ziprazadone and aripiprazole (new medications to Canada, coverage varies). Older antipsychotic medications that have some antidepressant effect, although more than the prior tow mentioned are Risperdal at 0.5 to 2 mg daily, or Seroquel at less than 300 mg. daily.

Cognitive behavioral therapy (CBT) is also helpful for depression, and would perhaps assist the non-compliance. Alcohol is a depressant, and always makes bipolar illness worse, particularly the potential for suicide or violence.

Best treatment for depression and mania is electroconvulsive therapy, however it is not ideal for maintenance. Antidepressant are the most commonly prescribed medications for bipolar disorder, however the scientific evidence is quite clear, that they have only short lived antidepressant action for bipolar patients, and they cause mania and destabilize moods.

Please speak to your husband to work with his doctor, and see if his psychiatrist agrees with these thoughts, as his doctor should know best from seeing your husband.

Hope that helps, and thanks for writing.