Expert: Ivan Goldberg, M.D. - 12/13/2011

Question
Dr.Goldberg ,
i am a case of MIXED BIPOLAR with 90% depression and 10% manic components.i didn't used to tolerate any medicine , but when taken in combination, of valporate 1250mg ,olanzepine 7.5mg,lithium 600mg and venlafexine 75mg i am tolerating 50 -60%.....
Sir,
1)are antidepressants contraindicated in bipolar depression?? 2 psychiatrists in my city have advocated taking antidepressants.
2)any you suggest anything else to make this combition stronger and make me tolerate the medicines more.
3)would i develop resistance to this combination later on.

Much thanks an best regards.

Answer
Hi, Karan . . .

It has been my experience that about 2/3 of people with bipolar depression can be successfully treated without the use of antidepressants. While some people do need antidepressants, others with bipolar depression have severe negative reactions to antidepressants. Rapid cycling, mixed states, and switches into mania can all be caused by treating people with bipolar depression with antidepressants.

I have found that the best combination of medications for the treatment of people with bipolar depression is the combination of lamotrigine and lithium.

The answer to your first question is that antidepressants are not absolutely contraindicated as a treatment of people with bipolar depression, but that their use should be limited. I suspect you are aware that you are taking a antidepressant in the form of venlafaxine.

As I mentioned above, I like to use the lithium-lamotrigine combination to treat people with bipolar depression.

Your third question is very interesting because people with bipolar depression who are treated as if they have major (unipolar) depression, may initially respond to antidepressants but soon develop resistance to the antidepressant and show a return of their depression. This is less likely to happen when they are treated with the lithium-lamotrigine combination.

Best regards . . .

Ivan
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