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    Dear Dr. Goldberg..would like your opinion on the following...
    AZHomegirl posted:
    my husband was diagnosed in March of 2009 with Bipolar and he remained stable for the next 3 years on 900 mgs of Lithium and 450 mgs of wellbutrin. in May 2013 current psych at the time changed his lithium to lamotrigine and my husband has not been able to get stable since then. I switched to a private pay dr in hopes of getting a better care at higher cost...this dr immediately started ECT treatments and it made the depression worse and extensive memory loss. He tried starting him on Depakote but that made him so lethargic and unable to put a thought together or express verbally. He is suggesting IV Ketamine drip and/or clozapine weekly monitoring. I am not ready to do that as I think it is extreme and we had bad reaction with we settled with adding to his regular regime of 450 mgs of Lithium 2xday, 1 mg Clonazapam 1 at bedtime, Tegretol 200 mg 2 at bedtime and 1 in morning, Latuda 60 mgs 1 tab in morning to get result of 30 mgs since it counteracts with Tegretol and for sleep ambien 3 10mg your opinion could this be husband has not had a manic episode in 2 years and I don't understand why he is on so many strong mood stablizers...any info would be appreciated
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    Joseph F Goldberg, MD responded:
    Dear AZHomegirl, Generally, if someone has a good response to lithium, it makes sense not to mess with that unless there's a very compelling reason to do that. Lamictal and lithium do vastly different things so it's unusual to think of "exchanging" one for the other -- lithium mainly treats mania and less so depression, while lamotrigine mainly treats/prevents depression more so than mania. Do you know why lithium was stopped in the first place? Dr G

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