Expert: Ivan Goldberg, M.D. - 6/11/2009

Question
I was being treated solely for depression for many years and was taking 100 mg Seroquel (to sleep), 150 mg of Welbutrin, and 60 mg of Paxil with success until 11/2008 when I felt my mood swing indicated I may have bi-polar disease (as my adult son has been diagnosed). I wanted to get off some of my medications, so I gradually stopped taking paxil (as the withdrawal was extremely harsh) and my psychiatrist started me on 100 mg of Lactimal/day - with no titration period???.  It seemed to work the first few months, however, in May/09,I began getting extremely depressed and my dose of Lamictal was increased to 150 mg/day.  I took 150 mg a day for 3 weeks, however it did not seem to help and the side effect of blurred vision is intolerable.  My doctor now has started me on 10 mg of Celexa, in addition to the Lamictal, Welbutrin, and Seroquel.  I requested to be taken off of Lamictal, however he doesn't want to yet as he does not want to "make too many changes at once".  I would like to know your opinion on if the introduction of 100 mg of Lamictal was too quick for my body to adjust (even though I felt no bad reactions when I started taking it in November) or perhaps, the medication is not for me.  I would also like to know how successful Celexa is for patients who are depressed.  Thank you.

Answer
Hi, Marie . . .

the treatment of people with bipolar depression is one of the most controversial areas of psychiatry these days. Some psychiatrists believe that antidepressants such as Paxil and Celexa should never be used while others, including me, believe that they should ONLY be used when people are takingg a major antimanic drug such as lithium.

Most psychiatrist I know would start a patient with 25 mg, not 100 mg, of Lamictal. This is because when people are started on large doses, there is an increased risk of the person becoming allergic to the drug. It has been my experience that the combination of Lamictal and lithium is an especially useful combination.

Best regards . . .

Ivan
%%%%%%%%%%%%%%%%%%%%%%%%%%%%%