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    Dr G. question
    ttsmile posted:
    I have been diagnosed as bipolar disorder mixed. Bipolar 2 fits me very well, especially the high activity levels and lack of need of sleep, followed by a crash completely into depression. The dr diagnosed me after becoming very agitated and a little agressive on a tricyclic antidepressant. He put me on another anti-depressant--celexa, which did nothing for the depression (a little for the anxiety) but made me wound-up followed by crashing really low rather quickly. Now I am on abilify, wonderful medicine. I have no depression, thought tend to be rather impulsive and am needing sleep less. No full on mania, though. My question is, Is the implusiveness getting worse something I should be concerned about, or just learn to manage?
    Joseph F Goldberg, MD responded:
    Dear ttsmile,

    Not sleeping and uncharacteristic impulsive behaviors can be symptoms of residual or undertreated hypomania. Have you asked your doctor about giving you a mood stabilizer? Depakote is probably the best-studied mood stabilizer for the treatment of mixed episodes and, unlike Abilify, has been found to treat depression as well as hypomania. Studies also have shown that the combination of a mood stabilizer such as Depakote plus an antipsychotic such as Abilify may be more effective than 1 drug alone.

    We tend to favor mood stabilizers over antipsychotics for the long-term since mood stabilizers are better studied and do not carry the risk for tardive dyskinesia, diabetes, or high cholesterol associated with atypical antipsychotics as a class; antipsychotics are more often short-term treatments, especially when psychosis is present (in contrast to bipolar II disorder, where by definition there is no psychosis during high periods) rather than preventatives against relapse after an acute episode has remitted.

    Dr. G.
    ttsmile replied to Joseph F Goldberg, MD's response:

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