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Diag MDD 20+ BP?? Help
cherry1435 posted:
I have been treated for 22 years for MDD and recently visited my doc because I had so many things flying through my mind, no concentration, etc. Suddenly it was like I saw a lightbulb go off and he said no wonder you have had such a poor outcome with all the meds we have tried, asked a bunch more questions and was convinced I have a "mood disorder" as he called it during that visit. He started me on Lithium 300 2Xday mid May and continued taking 2 mg Xanax like I have for years to sleep. Immediately felt better for 2 weeks but then sank into one of worst depressions in years. Made apt when my family said I had started interrupting, not listening, rambling from one thing to another, etc. yet I am at one of my all time lows and NEVER feel hyper, excited, etc.?? He increased the lithium to 300 X 3 and added Lamictal (lamotrogene) 50 mg daily. Started this last Friday and am still the nothing all day except lay around waiting on my next dose hoping that will be the one that gets me up and moving around. Does this sound like normal way to treat? Do I wait 2 more weeks (next apt) or pay another 50 to go earlier b/c I feel so low? What does the "more normal" that I am looking for feel like and is it any better than what I feel now? Thanks for any help with insight into bipolar and or the meds I am on.
Joseph F Goldberg, MD responded:
Dear Cherry1435, Lithium plus lamotrigine together are an evidence-based treatment for bipolar depression. Unfortunately making a diagnosis of bipolar disorder does not mean there are highly effective treatments for it, or treatments that are markedly different from those used in major depression -- antidepressants tend to work less well in bipolar than unipolar depression. Sometimes an antidepressant is added to a mood stabilizer but again, results can vary greatly. See the video about treatments for bipolar depression under "Resources" here. Also, dosing with lamotrigine per the manufacturer is rigid: 25 mg/day for 2 weeks then 50 mg/day for 2 weeks then 100 mg/day for 1 week then 200 mg/day as the target dose. Faster dosing does nothing to make it work faster but drastically raises the risk for a serious skin rash, which presumably your doctor explained to you. Dr. G.

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Joseph F. Goldberg, MD, is a Clinical Professor of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY. He also maintains a private prac...More

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