Expert: Ivan Goldberg, M.D. - 1/31/2008

Question
My 18 y.o.son was diagnosed and began treatment 2 years ago for Bipolar II disorder and has had treatment resistant depression. He is currently on Lamictal, Lithium, Synthroid, and Seroquel for sleep. For the past three months, he has been having ultra rapid cycling -- his mood changes day to day if not hour to hour and includes profoundly deep depression. Are there other medication regimens we should consider? What about adjunctive treatments like lightbox therapy/"dark therapy" or fish oil? Any insights into possible treatments would be very welcomed!

Answer
Hi, Mary . . .

When treating someone with bipolar-II disorder hat is rapidly cycling here are a few of the things i do and do not do with my patients:

1. I totally avoid the use of antipsychotic medications unless there are hallucinations, delusions or other symptoms of psychosis/ Do a Google search on tardive dyskinesia  for one reason and another search on neuroleptic malignant syndrome for another.

2. Lamictal is often useful but often it has to be combined with other mood stabilizers such as lithium, Tegretol, and/or Depakote. While many psychiatrists are reluctant to combine these medications because of the interactions between them, experienced psychiatrists often make use of such combinations.

3. I usually suggest EPA, one of the substances found in fish oil, in doses of 1,800 mg a day.

4. I instruct my patients to remain in bed, asleep or awake for 8-hours every night.

I do not think you should initiate ANY of these techniques without discussing them with your son's psychiatrist.

You might think about getting a second opinion from one of the expert psychiatrists listed at:
http://www.psycom.net/depression.central.psychiatrists.html

Best regards . . .
Ivan
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