I have bipolar 2 disorder with more depressive episodes than hypomanic. Please help.

Question

Hello doctor,

I have bipolar disorder II and diagnosed with social and generalized anxiety disorders. Currently, my medication fails to uplift my depression. I take lithium 3x450 mg, Olanzapine 5 mg, Escitalopram 20 mg.

Previously I tried Valproic acid, Carbamazepine, Topiramate, Zoloft, Prozac, Clonazepam, Tranxene, Rudotel, and Lexotanil. I experience more depressive episodes than hypomanic. And I cannot take Lithium anymore due to kidney damage done.

What are my treatment options? We are considering changing to Lamictal, and a small dose of Wellbutrin. What do you think about this?

Answer 1

Hello,

Welcome to icliniq.com.

Yes, bipolar depression is difficult to treat and it can be persistent. Many people do respond to a combination of Lamotrigine and Quetiapine (popularly called as Lami-quel). It takes time to act, but it is highly effective.

Currently, I would suggest that instead of Lithium you use Lamotrigine 25 mg x 2, then 50 mg x 2 and finally 100 mg x 2. Dose titration is every two to three weeks. Instead of Olanzapine, I would replace it with Quetiapine 50 to 100 mg for start and raise if needed based on the sedation.

Also, continue Escitalopram if needed or replace it with a TCA (tricyclic antidepressant) class of antidepressants. And yes, do add Bupropion (Wellbutrin). Also, you can consider doing a few sessions of rTMS (repetitive transcranial magnetic stimulation) if possible.