Expert: Ivan Goldberg, M.D. - 4/7/2009

Question
QUESTION: My 17 year old is in recovery from a drug addiction for about 6 months or so. He had had some dry drunk behaviors on and off which, other than the drug use, he hasn't had any peculiar behaviors. He's social,thoughtful, warm, pretty easy now that he's off of drugs and was this way before use, too.

My son may or may not have/had depression which is one of the two reasons he wanted to see a doctor. Since he's struggling in school (can't concentrate or focus) he had asked to be put on ADD meds, like his friends who are in recovery, too. Son had his first dr appt. two weeks ago and the doctor didn't advise ADD medication because of his drug addiction problem. Instead he put my son on Wellbutrin to help the "depression",help his ADD, and to ease his cigarette cravings. Today, however, the doctor also prescribed Limictal to prevent any future bipolar problems he might have because of the risk factors he has (my MOTHER'S two siblings were bipolar). The doctor explained to me that it's better to treat it as this end rather than wait, only to find he does indeed have it. He said, at that point, it's much more difficult to treat.  

My son and I aren't quite sure about this approach. Is this very common?  What happens if he doesn't have it?  How would this drug be beneficial? What if he is found to have bipolar but isn't sure and then stops taking it? I honestly DO NOT THINK HE HAS IT.

Confusing..........



ANSWER: Hi, Karen . . .

Lamictal is a medication that is useful as a treatment for both people with bipolar depression and major (non-bipolar) depression. The approach that the doctor suggested is one that I frequently use in my practice.

While Wellbutrin has some anti-ADD activity, it is not nearly as effective a treatment as one of the stimulants. Unfortunately, all os the stimulants can be taken in an abusive manner.

Best regards . . .

Ivan
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---------- FOLLOW-UP ----------

QUESTION: Thank you very much Ivan for your very quick response and helpful advice!!!!! I do have another question, however: I know my son doesn't have major depression, for sure. Would you still prescribe this mood stabilizer even though there aren't any signs of major depression? My other son had major depression and it was so evident - I could "feel" it in the air.

Answer
Karen, Hi . . .

There is no way you can know what your son's diagnosis might be. And there is no way I can know what the best treatment for him might be. But on the basis of the information you supplied it is my opinion that people with a personal and family history similar to your son's, often do best when treated with Lamictal.

Best regards . . .

Ivan
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