Expert: Ivan Goldberg, M.D. - 5/25/2011

Question
I wrote to you before RE questions about bipolar... i has said that i thought i was experiencing symptoms of hypomania... but have a diagnosis of Borderline personality disorder. I told my doctor about the symptoms so she reduced my lamictal from 100mg to 75mg and said that the hyper activity was caused by too much lamictal and i was just becoming stable after my depression but since i started the reduced dose i have become depressed again. Could you give me an idea of what this could mean? I have been depressed for about a week now after about 3 weeks of hyperness. Also while i was experiencing the hyperactivity i had a few episodes of sleep paralysis could this also be an indication of bipolar disorder?

Answer
Hi Kiera . . .

Lamictal is of benefit to people with bipolar disorder and/or borderline personality. Too much of any antidepressant can induce hypomania . . . especially in people who have symptoms that put them into the bipolar spectrum. It is not unusual for someone to have symptoms of both bipolar disorder and borderline personality disorder.

Sleep paralysis does not help with the diagnosis.

When I have a patient who responds to treatment as you do, I treat them with the combination of Lamictal and a mood stabilizer (most often lithium).

Best regards . . .

Ivan
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