Hi Jmir,

Apologies for my delay in replying. I am assuming your friend is dealing with Bipolar Disorder. On that premise, lithium is a very good mood stabiliser. I have heard good things about a combination of Lithium and Lamotrigine(also a mood stabiliser but better for the depression in a down phase). If your friend experiences psychotic mania, carbamazapine(tegretol) alone would be in question for these episodes. Your friend may benefit from a mild anti-psychotic/mood stabiliser(seroquel) but I am not sure of their intractability. This will help in the manic phases as well as provide a sedative effect. I have been on lithium and Olanzapine(Zyprexa) combination in the past, but it was found that I do not have bipolar. However, a friend of mine has bipolar type I and it works well for her. Olanzapine has a very negative side-effect which is weight gain.

And yes, as we get older our metabolism changes as does our ability to excrete waste through cellular respiration. Any of these psychotropics need to be monitored closely as they can can effect the thyroid, kidneys and liver. With lithium, your friend would need regular blood tests(lithium only works if its blood level is at a certain point) and liver function tests.

Sodium valproate(Epilim) is also an anti-seizure medication used for mood disorders. Your friends options are quite varied and it sounds to me like he really needs to have his meds reviewed. Does he have a psychiatrist? Some talk therapy would also not go astray. As we get older, we sometimes find that our needs and priorities change. It is good to able to talk to a therapist about these changes.

Just a note, depending on the age of your friend, hormone changes can also effect metabolism. Even men can experience significant changes in this area. He needs to get a full physical and hormone panel done, just to make sure that he is healthy physically. It could also explain any extremes in mood changes he may be experiencing with little or no obvious pattern to them, if that is the case.

Take good care and good luck.

Michah