Expert: Ivan Goldberg, M.D. - 10/28/2008

Question
Hi.
I've been taking Wellbutrin and Zoloft for about 6 years for depression.
A couple of years ago my psychiatrist diagnosed me with mild bipolar disorder.  He
prescribed Lamictal, which I've been taking ever since.  It does help  me in terms of
my depression, but since I've started taking it, I'm tired almost all of the time.  I
don't have energy to do anything beyond what's absolutely required of me.  I've
become lethargic and unmotivated and I find myself doing less and less.
I'm a 45 year old male, but I'm starting to feel like I'm 90.  Do you have any
suggestions for bipolar meds that might not have this side effect?
I'd really appreciate any suggestions that you might have.
Thank you,
Steven

Answer
Hi Steven . . .

I have had a few patients who have complained of excessive fatigue while taking Lamictal. I usually suggest that they reduce their dose my 10% of their dose every 2-3 weeks. If the fatigue disappears at some point, without a significant increase in depression, the new dose has been determined. If the depression starts to increase prior to the fatigue disappearing, I usually switch them to a combination of lithium and Wellbutrin.

Best regards . . .

Ivan
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