Brief Answer:
Please see details below.

Detailed Answer:
Hi,

I went through your query in detail and will try to answer it in the best possible way.

From the details that you have provided, you seemingly were in depression for a period of time and were on anti-depressants. The manic episode that you are mentioning happened only after increasing the dose of effexor which makes me infer that it was anti-depressant induced mania. That manic episode too responded well to abilify and was over in a couple of weeks. From these details, you just narrow down to two possibilities:
1. Depressive disorder with anti-depressant induced mania
2. Bipolar disorder

It is very difficult to distinguish between the two and for practical purposes, we treat both on the lines of bipolar disorder.

However, there is no mention of any psychotic symptom in your description. As such, I am not sure of the schizoaffective disorder. It basically is a disorder in which a person has manic and depressive episodes and also have psychotic symptoms at some point even in the absence of the mood symptoms. So, at this stage, I would go ahead with the diagnosis of bipolar disorder.

Regarding medications, I am sure your psychiatrist must have good reasons for each of them. In the end, it narrows down to the fact whether you are responding well. If you are perceiving improvement, just go ahead with the medications. If not, some adjustments in the medications can be tried. One of the changes that can be considered is thinking about adding lithium to the regimen instead of lamotrigine. It is a mood stabiliser and has good response in resistant cases of depression too. If you are responding well to that, the dose of other medications like klonopin, trazodone and adderall can be reviewed and if possible tapered. But in the end, every decision regarding your medications must be made only after assessing current response and going very gradually about it.

I do hope I was able to answer your query. Please let me know if you have any further query. I will be glad to help.

Best wishes.

Dr. Sunil Gupta

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Brief Answer:
Please see details below.

Detailed Answer:
Hi,

Thanks for following up and clarifying things. More importantly, thanks for the appreciation.

Psychotic symptoms are quite common during manic episode. If your psychotic symptoms had been present only while you were in mania, the diagnosis still remains bipolar disorder. Only if the psychotic symptoms have occurred independent of any manic or depressive episode, the diagnosis of schizoaffective disorder is considered.

Frankly, in case of any of the two diagnosis, the treatment that you are currently receiving will be appropriate. Even the further course that I will consider in your case will remain same as mentioned in my last response. The thing to give importance will be that in case of schizoaffective, any one of the anti-psychotics (in your case, Abilify) must be continued. In case of bipolar, it is usually needed during manic episodes. Continuation when mania is over can be reviewed if you are on any mood stabilizer (lamotrigine or lithium).

I hope that answers your query. Please let me know if I can be of further help. It will my privilege to do so. In case, you don't have nay further queries, please do close the discussion and rate the answer.

Best wishes,

Dr. Sunil Gupta

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