Expert: Ivan Goldberg, M.D. - 11/24/2011

Question
I have read that antidepressants can send you into mania and rapid cycling Depending on what I read and from which country. Ausi doctors say not so. I am fairly certain I am BP 2. I have tried so many things. Now on 60 prozac and 200 lamictal. Been about 3 weeks. going to give it another 2, but I have no motivation what so ever, isolate, and the anhedonia just wont go. Getting so frustrated. How high can one go on prozac? 80?

Answer
Hi Tim . . .

While antidepressants can induce mania, rapid cycling, and mixed states in some people with bipolar disorder, antidepressants are not totally contraindicated in the treatment if such individuals.

When treating people with bipolar depression I often start with a combination of lithium and Lamictal. I dose each based on blood levels. With lithium I look for a blood level of about 0.8 mEq/L and with Lamictal about 8 mcg/mL.

The risk of antidepressant-induced mania is greatest in people with BP-I although some people with BP-II can also develop mixed states or rapid cycling. If someone who was taking what you are tasking came to me as a patient, the first thing I'd do is a Lamictal blood level and then readjust the dose to one that would be accompanied by a level of about 8 mcg/mL. If that did not bring about a remission from the depression, I'd add lithium, and only after the lithium blood level reached 0.8 mEq/L would I slowly increase the Prozac. I seldom Rx more than 100 mg/day of Prozac.

Best regards . . .

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