Expert: Ivan Goldberg, M.D. - 12/5/2011

Question
Hi Dr. Goldberg,

I hoping that you can lend me your expert opinion. I am Bi Polar 2 and over the summer started taking Depakote. Then we added Seroquel. I felt great! The perfect combinations for my symptoms. But a couple months after I started to take the Seroquel, I started to have hot flashes, extreme sensitivity to any type of heat, a burning sensation mainly on my neck and shoulders, and an overall very uncomfortable feeling of being hot. It was very very bad and took four months to pass. I very much need to get back on the Depakote but am afraid. What would be your best guess as to which medication could produce this effect in the body? I am currently on Lamictal and Celexa but suffer from depression, rapid cycling, and major amounts of anxiety. Have you ever heard of this with either drug, more specifically with Seroquel?  A few people I spoke with thought it was the Seroquel but if it was the Depakote then I am in trouble because I have tried and do not respond to Lithium. Any thoughts?  Ideas of another medicine to combine with lamictal for control of Bi Polar 2 symptoms? Thanks so much for your advice and help. It is much appreciated!!

Answer
Hi, Greg . . .

I have never run across a patient who developed the sort of reaction you describe. There is no way that I can tell you which of the drugs you were taking might have been responsible for the side-effect. I can point out to you that with few exceptions, I only prescribe antipsychotic medications such as Seroquel, when an individual has psychotic symptoms.

If someone came to me with the history you provide, I would prescribe the combination of lithium and Lamictal. This would be true even if they told me that they had not responded to lithium in the past. It has been my experience that the combination of Lamictal and lithium often is effective when lithium had been ineffective in the past. If the lithium-Lamictal combination did not do a complete enough job of controlling bipolar-II symptoms, the next medication I would add is carbamazepine (Tegretol).

Best regards . . .

Ivan
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