Expert: Ivan Goldberg, M.D. - 11/20/2010

Question
llo, thank you for volunterring your expertise and time.
I am considerd Bipolar 2 or having a mood disorder.
I am currently on Seroquel  100 mgs at night , started that over a year ago for irritability /agitation and rage.
But afterawhile it didn`t help with my depression so I was put on Prozac, worked well for about 1 year then I experienced 'emotional blunting"
, so next came Wellbutrin, the dose was originally to be 100mg , 3 times daily, I can not take sustained or extended release, just imediate release.
well this dose of 3 times daily had me bouncing off walls, was so speeded up I couldn`t stand it.
My Pdoc dropped me to 100 mg 2 times a day, the 1st 4 weeks were absolutely wonderful, I was motivated , energized and felt great, about week 6 the irritabilty came into play, and if the irritant didn`t go awy , I would go higher into agitation  and even mild raging.
Now my Pdoc wants me to try 75 mg 2 times a day to see if those side effects might go away.

Now I take a low dose of seroquel and I know alot of people take 6 times that so I am wondering and asking if this low dose of wellbutrin could help or would you consider it too low for any good?
I guess time will tell?         Just looking for an opinion to share with my Pdoc at my next appt.

I would hate to go off wellbutrin because I was so unmotivated on the prozac, literally stayed in bed and had zero joy about life, even the birth of my grandchild brought no joy, so this new found joy, and motivation and pleasure for life is a Godsend.
If I did need to stop completely what do you think my Pdoc could replace it with?      I think I need something that ups my dopamine.

Not looking for advice to use against my own Pdoc , but an opinion to bring to him.

Thanks and I hope you can answer this .


Answer
Hi Jen . . .

The treatment of depression in people with bipolar-II is challenging. The usual story is that antidepressants work for some period of time and that then either the side-effects of the antidepressants or some irritability, hyperactivity or some other manic symptom gets in the way.

It is my practice to suggest that all of my patients with bipolar-II be on lithium, Tegretol or Depakote PRIOR t the prescription of any antidepressant. I consider Lamictal t be essentially an antidepressant is most often prescribe it to control the bipolar depression. On other occasions I will prescribe Wellbutrin or one of the other antidepressants. I generally avoid Effexor and Cymbalta as I have seen too many people with bipolar depression become manic when they take one of those.

Lithium + Lamictal is my favorite treatment for people with bipolar depression.

Best regards . . .

Ivan
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