Expert: Ivan Goldberg, M.D. - 2/7/2008

Question
Dear Dr. Goldberg:

We are planning a retrial of Wellbutrin/bupropion to treat my nine-year-old son, who has bipolar disorder with a pattern of serious winter depression.  (He is taking lithium, which has helped, but not enough; and numerous adjunct drug trials have not worked out for him.)  Although Wellbutrin clearly helped when we tried it in the past, we were always forced to drop it because of stomach side effects.  One doctor suggests we try administering bupropion through a patch prepared to order at a special pharmacy, so that we can bypass the stomach altogether.  Another doctor has reservations about the patch, since it has not been tested, and suggests that instead we try "extended release."  But the smallest abailable dose in the Wellbutrin XL is 150 mg, which would preclude the possibility of gradual titration.  (My son weighs about 100 lbs, and the highest dose he ever got to was 112.5 mg.-- though, our understanding is that, for this particular drug, that's not all that much.)  Do you have any thoughts on which of these methods makes the most sense?  Or do you have any advice on how we should go about deciding which method to try first?

Thank You,
Sarah

Answer
Hi, Sarah . . .

I am not enthusiastic about the use of antidepressants in anyone diagnosed with bipolar disorder. There are many reports of antidepressants causing irritability/hypomania or mania in such people; also of them causing mixed (manic   depressed) states, and of antidepressants causing rapid cycling between mania and depression.

Bright light therapy and if that did not help, Lamictal would probably be my initial treatments if I were asked to treat a patient such as your son. The EMSAM patch, particularly if you son were taking lithium, is  another possibly approach.

Best regards . . .
Ivan
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