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

Answered by
Dr. Parth N. Nagda
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Mar 11, 2020

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?



Welcome to

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.

Was this answer helpful?


Same symptoms doesn’t mean you have the same problem. Consult a doctor now!

Related Questions:
Which medicine, according to you, is best for my psychological disorders?

I am afraid to get out of my home due to my constant anxiety symptoms such as sweaty palms and feet, chest pain, high blood pressure, and racing heart ...   Read full

Can you list the drugs incompatible with Quetiapine and Lamotrigine?

.. for Lamotrigine following drug interactions need to be considered as important. Valproate increases plasma level of Lamotrigine, hence dose need to be decreased if given with Valproate. Also there are increased chances of rash if given with Val...   Read full

What should I opt for bipolar depression, Lamotrigine or ketamine infusion therapy?

.. understand your problem. Ketamine infusion therapy has great roles in depression but regular maintenance treatment is needed and which results in a significant burden on patients. Lamotrigine is the right drug for resistant depression. Even in mai...   Read full

Also Read Answers From:

ideaComprehensive Medical Second Opinion.Submit your Case

Also Read

Monkeypox Virus - Symptoms, Diagnosis, Treatment, Complications, and Prevention
Monkeypox is a zoonotic viral disease. This virus got its name as it was first noticed in laboratory monkeys in the late...  Read more»
Tomato Fever - Causes, Symptoms, Diagnosis, Treatment, and Prevention
Tomato fever is an unidentified and fast-spreading type of viral infection seen in young children. Scroll down to know m...  Read more»
Histrionic Personality Disorder - Causes, Signs, Symptoms, Diagnosis and Treatment
Histrionic personality disorder causes variations in the thinking ability of a person. Read this article to know more.  Read more»

Ask your health query to a doctor online?

Ask a Psychiatrist Now

* guaranteed answer within 4 hours.

Disclaimer: No content published on this website is intended to be a substitute for professional medical diagnosis, advice or treatment by a trained physician. Seek advice from your physician or other qualified healthcare providers with questions you may have regarding your symptoms and medical condition for a complete medical diagnosis. Do not delay or disregard seeking professional medical advice because of something you have read on this website. Read our Editorial Process to know how we create content for health articles and queries.