55 years Old male with Bipolar affected disorder moving from depression to Manic to depression phase

Disclaimer:-

This is a HIPAA de-identified open-online-patient-record with initial information in patient's voice, posted here December 2017 after collecting informed patient consent (form downloadable Click Here)

This is a case of a 55 years old, diabetic, hypertensive patient who was diagnosed with Bipolar affected disorder since 1995. In 1995 due to financial loss he was attacked by this condition. He was seen by Dr. D. K Agarwala and diagnosed as BPAD-Depression phase and treated with lithium, sodium valporate, propranolol, Zeptol cr, Nitrosum - S. 

With the treatment he was reasonably well but every 6 months of interval he appeared to have some disturbance like didn't want to talk to anybody, forgot to smile etc. They went to the doctor and treated accordingly and was continuing the treatment. 

In the year of 2013, August he was diagnosed with BPAD-severe depression phase but, he was not responding well to the medications and then they went to NIMHANS for better treatment. In NIMHANS, they took consultayion of Dr. Ravi panday sir and has been posted for (electroconvulsive therapy) ECT. He took 7 cycle of ECT and after that continued medication 1.Velnaflexin 2.Mirtaz 3.clonazepam 4.Stilnoct 12.5mg (for 10days).

After taking ECT and continued medications he had recovered well. In the year of Sept 2014, his condition was deteriotedand he was diagnosed with BPAD-manic phase and suddenly he switched from manic to depression phase again. He lost his momentum, ruined his business. We went to NIMHANS again and they treated with the medicines (prescriptions attached attached below):

From January 2015 to 2017, he took treatment of a psychiatrist in Bangladesh and continued his treatment but was not responding well to the medicines as well. From July 2017, he started some new medicines as per the doctors advice (prescriptions attached below): 

Medicines taken between 2015 to 2017 are below: 

But After starting those medicines, started to have lots of new symptoms which didn't have previously. (Current problems)

1. can not concentrate anything

2. decrease perception of time

3. Short time memory loss 

4. Can not control him during walking even during wearing shirt

5. Abnormally expression of feelings unrelated to the topics discussed. 

6. Talk at night during sleep.
7. Can't understand the transactions or accounts.

8. Unable to reply any relevant conversation.
9. Slurring of speech.

His Latest Prescription is: