Q. Dear Anna, My daughter is currently on Geodon 160mgs, Abilify 15 mgs, effexor er 150 mgs, litium er 1200 mgs. Moods are very stable, but paranoia and fear of being away from home pretty severe. She was recently weaned of risperdal due to side effects. She asked her pdoc for a tranquilizer to use as needed to get her through getting out as she is very frustrated and bored by having to stay home. Her doc said she would not give her controlled substances and is trying to tweak out the aps which are not effective. I'd appreciate any feedback, info, suggestions that you could offer. In a prior post, you mentioned that maybe the doctor could add on an additional MS. WOuld this have an antipsychotic effect? If so, which one(s)? Her moods are very stable and she has stopped SI and talking of suicide (after having been on lithium) Also, since she is so stable moodwise, should I be concerned about all the FDA warnings of AD's in kids? Thanks.

A. Mood stabilizers often help psychotic symptoms when those symptoms are a direct result of an affective episode (mania or depression). They do not act directly as antipsychotics. My advice is to attempt to determine if the paranoia and fear is a part of the mood disorder, or if those symptoms are part of a completely separate disorder that are just more obvious now that the mood swings are less severe. Your daughter may need treatment with an antianxiety medication. BuSpar is something you might want to consider as it is nonaddictive and generally does not cause the side effects so common when taking the benzodiazepines (valium, xanax, ativan)

Even though your daughter is currently stable, I would still be very cautious when using the SSRI antidepressants. If they are necessary, I would start with the lowest dose possible and increase it very slowly. Your daughters mood should be monitored very closely while taking any antidepressant medication.

I hope this helps.
Anna