Expert: Ivan Goldberg, M.D. - 10/30/2010

Question
Dr., I was dx.with bp 1 yrs ago, I am now 49. I am on total disability. I see a Psych. 1x per month, meds: 1500 dep er, 400 effexor xr, lamectal 25mg bid (not consistent with it). topomax 25mg bid (just beginning it again). Seroquel 100-200 for sleep. I have gained 30-40 lbs in last 2-3 months, already was obese. I am in a major dep. and cannot seem to climb out. Going to have lab work done this week. ?'s: Have I been on Dep. too long? Ser., get up in the middle of night craving carbs. have SI, see a therapist;, don't want to or plan on acting SI as I am devoted to my 10 yr old daughter. I am going to ob-gyn this week, could being perimopausal have anything to do with this dep?

Answer
Hi Christine . . .

Most people with bipolar depression will be helped if they take adequate amounts of antidepressant medications. Unfortunately many psychiatrists are so afraid that antidepressants will make their depressed bipolar patients manic that they undertreat the depressive aspect of the illness.

It has been my expedience that many more people with bipolar depression require doses of Lamictal of 200 mg/day or even more than that. The proper dose of Lamictal can be determined by blood tests just as such tests can reseal the proper dose of lithium or Depakote.

I think you should get a second opinion from a senior psychiatrist in your community or from one of the experts listed at:
http://www.psycom.net/depression.central.psychiatrists.html

Best regards . . .

Ivan
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