Brief Answer: Medications will be effective Detailed Answer: Hello, Thanks for choosing health care magic for posting your query. I have gone through your question in detail and I can understand what you are going through. I understand that you have bipolar mood disorder and are on good drugs such as lamictal, abilify, prestique. These are good medications and all of them are metabolized in liver. Your smoking and drinking coffee will effect the metabolism of these drugs and the doses need to be adjusted.However these drugs will still be effective inspite of you smoking and taking cigarettes. Smoking is very common among the patients of bipolar mood disorder, but still they do get well with treatment. Mostly if their moods are stable their smoking also reduces, and of course stooping to smoke will invariably be a very good solution if it can be done. Hope I am able to answer your concerns. If you have any further query, I would be glad to help you. If not, you may close the discussion and if possible you may rate the answer for me, so that I get a good feedback. In future if you wish to contact me directly, you can use the below mentioned link: bit.ly/dr-srikanth-reddy Wish you good health, Kind regards Dr. Srikanth Reddy M.D.

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Brief Answer: Information as asked Detailed Answer: Hello Thanks for your follow up information and question. Yes, you are right in understanding that metabolism will be effected but its not possible to determine that to what extent it will be effected as every human body works differently. For some it may not even matter. Its not possible to biologically measure the reduction in efficacy of a specific drug in a specific human being. For example even if you are not smoking or drinking coffee, the depression may respond to drug A at 10 mg and in some it may not respond to drug A at 10mg but respond to 20mg. Its practically not possible to identify, what dosage a particular person will be responding to. Similarly its not possible to determine to waht extent the interaction of caffeine and nicotine will have on the drug metabolism and to what extent the dose needs to be increased. If the response is not there then its required to increase the doses and if there is smoking involved then slightly higher doses should be tried. Every drug has its own side-effect profile. Like Lamictal increases the chances of skin rash and blood dyscrasias. Abilify can increase the chances of akathesia- (restlessness). Neurotin can cause sedation and prestiq can cause tremors, restlessness, and hypertension if the the doses are higher than that are required. If the dosage remains the same, and your symptoms are well controlled, then there is no need to increase the doses just for the same take that you drink a lot of coffee and smoke. In human beings and especially in psychiatric treatments, 2 + 2 is never always equal to 4. Hope that helps Regards Dr. Srikanth Reddy

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