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    (Dr G) Bipolar 1 disorder and PTSD medications
    reneegigliotti posted:
    What medications could be most effective when trying to treat both rapicd cycling bipolar 1 disorder with psychotic features and an increase in PTSD symptoms during depressive episodes? Do the medications over-lap? Current regiment, lithium (1125 mg), depakote (2500 mg), and seroquel (600 mg).

    Joseph F Goldberg, MD responded:
    Dear Renee, There isn't much overlap between medicines for psychotic mania and for PTSD. PTSD is usually treated with antidepressants, whereas antidepressants would be a bad idea during mania, or in people who have multiple episodes per year. There is no excellent treatment when 4 or more annual episodes occur other than to avoid antidepressants and use combinations of mood stabilizers, which appears to be exactly what your doctor is doing. There is a little research to support the use of prazosin specifically for nightmares in PTSD. Seroquel also has a little bit of preliminary research in PTSD, as does Depakote. Dr G.
    reneegigliotti replied to Joseph F Goldberg, MD's response:
    Thank you Dr. G. I will include your sage comments in my discussion with my Dr. G on Wednesday. He's trying to work with 2 problems simultaneously, rapid cycling bipolar 1 disorder with psychotic features and PTSD. He's taken a wait and see approach with the PTSD up until this point. He wanted to see if psychotherapy could improve the symptoms without medication. It hasn't. They are worse, particularly during depressive episodes.I think my treatment team and I agree we are past the watchful waiting point. Everyone is a bit frustrated and I'm worn out. I just want it to end.


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