Q. My 16 year old son is bipolar and acts out with sexual indescretions, such as obscene phone calls, poronograpy, martubation, has many legal problem resulting from this. He was on lithium and celexa, no help, we now have him on tegratol and celexa, he always appears manic, what might we add or change medication wise to help him with better judgment and thinking and lessen the sexual promiscuity?

  A. There are a number of other medications available that potentially can work. These include Geodon, Risperdal, Zyprexa, Lamictal, Topamax, Gabitril, and Neurontin. The more pressing issue is whether he has bipolar symptoms and these are used to describe the illness, but he also has a concomitant borderline personality disorder which contributes to the acting out behaviors. In this case, he would benefit from drugs like Celexa, but probably in higher dosages than have been used to date (at least 60 mg). Signs of concomitant BPD illness could include carbohydrate craving, headaches, migraines, irritable bowel, anxiety, obsessionality, long-standing sleep problems, and frequent mood changes.