May 17th, 2011
02:17 PM ET

Are my son's bipolar meds effective?

Every weekday, a CNNHealth expert doctor answers a viewer question. On Tuesdays, it's Dr. Charles Raison, an associate professor of psychiatry and behavioral sciences at Emory University, and an expert in the mind-body connection for health.

Asked by Manager

My son has biopolar and takes Depakote and Seroquel together. He doesn't seem that much better. Are there more effective drugs than these?

Expert answer

Dear Manager,

Your question strikes directly to the heart not just of psychiatry but of modern medicine itself.

For example, suppose you'd written in that your son had high blood pressure and had failed two antihypertensive agents. Are there more effective agents?

Because he was not responding to his current regimen, the answer would probably be yes. But if you then asked, "which ones are more effective?" we'd have to ask you to be more specific.

Do you mean "Are some medications flat out better than others?" or "Is there likely to be a medication that is better for my son in particular?"

As with high blood pressure, so in bipolar disorder. Studies suggest that certain medications may be slightly better than others in certain situations - in general - but there are not strong data that some medications are better than others in almost all situations.

On the other hand, anyone who either has or has treated someone with a mental disorder can testify to the fact that in any given individual, one drug can be a miracle worker while another can be worthless.

Every field of medicine has its holy grails, and a major grail for psychiatry is the ability to decide ahead of time which medicine would be best for which person. If only we could do this, we would spare our patients and ourselves all the troubles inherent in having to act "empirically," which is a fancy word for "trial and error."

Again, psychiatry is far from alone in this dream. A very good friend of mine is a top brain cancer researcher. He spends his life trying to figure out ways in which each glioblastoma brain tumor is different from every other glioblastoma brain tumor so that he and others can eventually design treatments targeting each tumor's specific areas of biochemical vulnerability.

As complex as tumor biology is, it is dwarfed by the complications inherent in brain and behavior.

So it is no surprise that we psychiatrists are behind our oncologist colleagues in the quest for "individualized medicine." Nonetheless, we are not without our promising early findings.

For example, studies suggest that brain scans, electroencephalograms and certain genetic tests hold promise for detecting ahead of time who will and will not respond to medication treatment for conditions like bipolar disorder. On the other hand, finding ways to identify which medication is the best one for any given person is a far more challenging task, and, in my opinion, we remain many years away from developing this ability in any way that would be clinically useful.

So for now, here is the bottom line, not just for your son but for all folks undergoing treatment for a mental illness. I sometimes say "symptoms are king," by which I mean that if what you are taking hasn't gotten rid of your symptoms, then it is not working and needs to be adjusted.

How to adjust it may be a matter of trial and error, but it is not completely random. A treatment plan is better exactly to the degree that a person's symptoms improve. It is optimal when the person is symptom-free.

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soundoff (41 Responses)
  1. Bobby

    Not everyone diagnosed as Bi-Polar has it.. Is there a blood test to confirm the disorder??

    May 17, 2011 at 14:41 | Report abuse | Reply
    • B

      No. As with most mental disorders, the symptoms and the ways in which they respond to treatment are the only ways to identify bipolar disorder. There is no blood test.

      May 17, 2011 at 15:00 | Report abuse |
    • Wrigley7

      Unfortunately, there are no blood tests that can reveal whether a person has or does not have a specific mental disorder. However, there are tests that can detect what specific genes a person has and how they may play a role. I highly reccommend an integrative medicine doctor who looks at the whole of a person, instead of trying to treat only the symptoms.

      May 17, 2011 at 15:03 | Report abuse |
    • jen

      It could be another mood disorder or BPD.

      May 17, 2011 at 15:25 | Report abuse |
    • Kayla

      No blood tests can confirm it.

      May 17, 2011 at 16:04 | Report abuse |
    • Jon

      There is no blood test, or any other biological test. The drugs used, such as depakote, abilify, etc.....are destructive D2 receptor blockers that cause permanent brain damage. Read Anatomy of an Epidemic to review the research behind psychiatric medications. Abilify is a perfect example of rogue psychiatry. They have no idea what it does, how it "supposedly" works, etc......they just claim "clinical studies have had positive results." It's crap. The "Different medications might work for you" line is just another scam hoping you'll get hit with the placebo effect, and keep coming back for meds. Psychiatry and their medications need to be eliminated from our society.

      May 17, 2011 at 16:54 | Report abuse |
    • COlady

      Jon, you are not a doctor nor do you sound like you've had any medical training. Please take your Scientology BS elsewhere. Until you have had your teenage daughter look you in the eye, sobbing, and tell you that she imagines what it would be like to put the gun to her head and pull the trigger, do NOT get sanctimonious and try to tell someone they are not truly ill. Medications saved my daughter's life. She says it amazes her how much more level, stable,and "normal" she feels; no more roller coaster, no more frightening images/thoughts. She's doing very well.

      May 17, 2011 at 18:17 | Report abuse |
  2. Ken

    Ask the doctor about Lamictal (Lamotrigine). Very effective for my daughter.

    May 17, 2011 at 15:02 | Report abuse | Reply
    • COlady

      Lamictal works for my daughter as well, but it took a while (and a different, more knowledgeable doctor) to get her on meds that worked well. It's made a world of difference.

      May 17, 2011 at 18:11 | Report abuse |
  3. Mickey Biancaniello

    Legalize Marijuana.

    May 17, 2011 at 15:29 | Report abuse | Reply
    • Dawn

      there is legal testing in Sweden for the use of Marijuana while the result for Major depression and cronic depress they had to stop the test for bipolar 1 and 2. When the test subjects enter the manic phase they became incredibly violent and suicidal
      so no do not give the kid any marijuana or let him be near anyone smoking it

      May 17, 2011 at 16:07 | Report abuse |
    • Bassman

      I am Bi-Polar 2 and smoke it all day

      May 17, 2011 at 17:01 | Report abuse |
    • Child care

      There may be some applications for medicinal marijuana, but not for children and not for depressive disorders. People on chemo are the people who might be able to benefit.

      May 17, 2011 at 17:16 | Report abuse |
    • S

      Weed does more harm than good to the brain. It shrinks parts of the brain and often causes mental illness to become worse.

      May 17, 2011 at 19:12 | Report abuse |
  4. Liz

    Lamictal worked wonders for me (bipolar type 2) as well, and I had no side effects. It might work for your son, its worth a try.

    May 17, 2011 at 16:43 | Report abuse | Reply
  5. Child care

    Also, these meds will not cure a mental disorder. They only help ease the symtoms of the disorders. I work with children with various depressive disorders. They are all on all kinds of meds. The meds help, but they all still have depressive disorders. No meds will cure these things.

    May 17, 2011 at 16:54 | Report abuse | Reply
    • Arick

      You are correct that their is no cure. However, different people will respond to the medication in different ways. I have bi-polar disorder and I take medication for it. My treatment has been wildly successful. I feel better now than I have ever felt in my life. The difference really is night and day. I still have episodes of mild depression and periods of hyperactivity, but they are much rarer and far less severe. My treatment has been so successful that I only see my psychiatrist once every four months.

      I do however realize that my results aren't typical, but for some people, the medication can work wonders.

      May 17, 2011 at 17:10 | Report abuse |
  6. Hopeful

    Lamictal works well for my 24 year old son with Bipolar 2; he takes geodon for psychotic features as well. He is doing great and has been stable for 2 years with only minor symptom breakthroughs.

    May 17, 2011 at 17:13 | Report abuse | Reply
  7. Panda

    If he's not having any manic episodes, those meds are working correctly. Depression could be treated with additional measures. I have found the depakote/seroquel combination to work for me for 10 years without any more episodes.

    May 17, 2011 at 17:14 | Report abuse | Reply
  8. Fox

    I have been on both Depakote and Lamictal before. Depakote gave me intolerable weight gain, and slowed me down too much. With Lamictal, I broke out in the dreaded rash on a high dose. Currently I am taking a Lithium/Seroquel combo for Bipolar 1 and an antianxiety med for anxiety. While far from perfect, it does seem to work better and with fewer side effects than previous meds. There are a variety of meds out there, perhaps a change in med would be of help. Best of luck.

    May 17, 2011 at 18:11 | Report abuse | Reply
  9. Fox

    I forgot to mention that I am also on an antidepressant, a decision not all doctors are comfortable with in Bipolar. I became manic when only treated with Lamictal which may have been influenced by the antidepressant, however I was able to stay with it once I switched to Lithium. Essentially, people are all very different and respond to different treatments in the same fashion.

    May 17, 2011 at 18:14 | Report abuse | Reply
  10. Ben


    I'm not sure if you've seen this video yet, but I would certainly recommend it to any parent who is dealing with the subject of child diagnosis and medications.

    The diagnosis of mood disorders, ADHD, and Bipolar disorders in children must not be taken with a light heart. Because of the fact that a child's mind is rapidly transforming and growing (Fresh neural connections are conducted at a substantially high rate compared with the rate of neural bonding within adults), medicine (particularly drugs geared towards the treatment of ADHD and bipolar disorders) that is directed towards adults does not typically have the same effect in children. In the treatment of children, it is not unlikely for psychiatrists to continually pile on new medicines, eventually for the purpose of counteracting the effects and symptoms of a different concurrent drug. The cycle is vicious. Be careful in the direction you take from psychiatrists and pediatricians concerning drugs. The leaders behind the bipolar classification movement are quite uncertain about the effectiveness and viability of the drugs they're advocating. They're making a hefty salary each year and they can be motivated by the thrill of creativity and invention, but such motivation can result in the exploitation of children for the purpose of experimentation.

    Also, it is imperative for Western societies to re-evaluate their communal perception of disorders. If an American traveled to a non-western nation, they would soon discover that the majority of parents delegate value to the thriving community. Attachment is important and can be reflected (in a most basically practical sense) sleeping arrangements. Americans value independence over collectivist/communal tendencies and as such it is expected that babies will either sleep in a crib away from the parents or in another room altogether. The value paradigm in the U.S. consists of graduating from college, getting a job, making money, and starting a family. In non-western cultures, the value is more directed towards the good of the community and therefore each individual's development is vital. ADHD, for example, is lacking in extensive existence in many non-western cultures primarily because the paradigm for human thriving goes beyond that of mere classroom education.

    May 17, 2011 at 18:26 | Report abuse | Reply
  11. b

    i have BP 2 and was diagnosed 5 years ago at age 15. was on meds for a while, none of them helped. found out i have other health problems down the road, and since i am not into psych meds and smoking weed has kind of unpredictable effects sometimes, i started seeing a homeopathic doctor, who recommended i remove dairy and gluten from my diet. have felt better than ever since (i've been doing this for 4 months now), with only a couple of traumatic experiences sending me into a crazy "up" phase. I think everyone should give the diet thing a try..it's amazing what a healthy diet can do for you on so many levels.

    May 17, 2011 at 18:50 | Report abuse | Reply
  12. Ken

    I have done a ton of these meds for biploar disorder. The ones that worked the best were the lithium/lamictal/seroquel combo. With that said, PLEASE if at all possible explore other options other than seroquel. I probably would have committed suicide because it did work and it did help get me to a place where therapy could help dig me out of my hole, but withdrawl and the side effects of seroquel are just horrid. As much as it sucks and I didn't want to believe it, getting regular exercise did help a ton with my issues, even though it's hard as heck to go try to exercise when you are having one of those days where life sucks to the point where you don't want to acknowledge anything.

    If you have to use seroquel, then do so, it's better than dying, but talk to your doctor and see if there is anything else you can do first.

    May 17, 2011 at 19:04 | Report abuse | Reply
    • Bethany

      my combo is Lamictal and Trileptal they work better then all the other med's I have takin. The side effects from seroquel were not Kosher for me..

      May 17, 2011 at 20:28 | Report abuse |
  13. Bethany

    My BiPolar medications saved my life...Really they did!!!!

    May 17, 2011 at 20:25 | Report abuse | Reply
  14. freek5

    unfortunately for all involved its really trial and error ... i have found that lamictal,abilify and zoloft work quite well...

    May 17, 2011 at 20:31 | Report abuse | Reply
  15. Tova

    Seraquel made me gain weight and NEED over 9 hours of sleep per night - not feasible.
    Lamictal did absolutely nothing, and I had a suicide attempt during it. Once I stopped, I felt much better. Just terrible.
    The only one that has worked for me is Topamax. Weird, weird side effects and not all doctors are comfortable with its usage for bipolar, but it's done wonders for me.

    May 17, 2011 at 20:46 | Report abuse | Reply
  16. erich2112x

    True classical, medically diagnosed manic depression is as rare as turrets syndrome. In the last 20 years, the psychiatric community has broadened the definition to include most of the population, and the RX industry makes billions.

    May 17, 2011 at 21:22 | Report abuse | Reply
  17. Gil

    Get into family therapy!!!

    May 17, 2011 at 23:36 | Report abuse | Reply
  18. Deja

    I would caution folks about the side effects involved in the use of Seroquel. I am a classroom teacher with several years of experience with students with special needs. Again and again high school students report to me that they never heard voices (auditory hallucinations) until they took Seroquel. I am not saying it will have this effect on everyone–I just wish parents consistently knew how significant of a drug this was before they embarked on its consumption. Likewise, I encourage teens to talk to their parents and doctors about side effects as they experience them.

    May 18, 2011 at 01:04 | Report abuse | Reply
  19. abird

    lithium orotate. worked for my bf now husband. He's a new man. all natural mineral that can be bought and not prescribed and no blood work.

    May 18, 2011 at 06:05 | Report abuse | Reply
  20. Phil

    Bipolar, not bi-polar.

    May 18, 2011 at 06:45 | Report abuse | Reply
  21. Bill

    When you are talking about children who have bipolar you need to think about the child's diet. There are studies that have found that some children develop moods problems when they eat/crave a lot of carbohydrates and/or when they eat foods
    that have dyes in them (hot dogs, red apples etc). Food dyes and a high carbs. diets have also been linked to attention deficit problems.

    May 18, 2011 at 07:18 | Report abuse | Reply
  22. angela

    Vicodin rules

    May 18, 2011 at 09:56 | Report abuse | Reply
  23. Nixza T.

    Depakote treats conditions that are notoriously hard to control, but Depakote's side effects seem almost as unwieldy as the diseases the drug was created to treat. Rapid weight gain, insomnia, diarrhea–even the lighter side effects are not all that light. Check out the full list of side effects: http://www.weitzlux.com/Valproic-acid-side-effects_1962907.html

    May 19, 2011 at 11:28 | Report abuse | Reply
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