Dr. G, if we lived in the perfect world of mental illness and you had a patient who was diagnosed with Bipolar I Disorder with a Panic Disorder w/o Agoraphobia, what would be the top three medications that you would prefer to prescribe to try and regulate the typical Bipolar I manic/hypo-manic symptoms as well as the anxiety that often comes along with this illness? And why would you prefer the medications that you choose versus other similar ones on the market? In other words, why would one medication that does the same exact thing as another medication be more favorable in the medical world?
It's hard to offer medication suggestions for diagnoses rather than for individual people, since no two are the same and a diagnosis per se doesn't plug in to any specific treatment. Sometimes non-medication approaches are better than medication approaches, depending on the patient and their personal history and circumstances. (Behavior therapy is very effective for panic attacks.) That said, Seroquel probably has the most data for the treatment of all phases of bipolar disorder and comorbid anxiety states. Zyprexa also likely has value in both conditions. Sometimes, a separate anti-anxiety medication (e.g., a benzodiazepine or Neurontin or Lyrica) added to any antmanic drug (eg, lithium or Depakote) is sometimes also reasonable.
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