Expert: Ivan Goldberg, M.D. - 7/3/2007

Question
QUESTION: Are bipolar racing thoughts, thoughts that are pleasurable?  Are they thoughts of planning to do things, involving being ambitious and goal oriented?  Or are they mostly like worries which won't go away, like if the mind won't shut up which can exhaust someone mentally?  I have been having worries spinning through my head and sometimes I have trouble focusing on one thing for more then a few seconds and have trouble reading.

ANSWER: Hi, Jennifer . . .

The racing thoughts that are found in people during a manic or hypomanic episode may be pleasant or unpleasant.  There is a unpleasant form of mania that is dysphoric rather than euphoric and people who are experiencing dysphoric mania often have their mind cluttered with anxious or even paranoid thoughts.

Some people with anxiety also report racing thoughts of an anxious nature.

Only a psychiatrist can help you determine if your thoughts are simply a normal reaction to a stressful situation or the symptom of a psychiatric disorder.

Best regards . . .
Ivan
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---------- FOLLOW-UP ----------

QUESTION: I was prescribed Lamotrigine in addition to my SSRI because my doctor suspects Bipolar 2 depression.  I also have OCD.  Have you ever found Lamotrigine to trigger obsessions?  After I increased my dosage to 50mg, I developed like I would describe a 'bad trip' of obsessions, which have been under control with the SSRI.  It's almost as if the Lamotrigine triggered the onset.  I had to stop it.  I also researched Lamotrigine and found out it increased the release of dopamine.  In your opinion, is this release of dopamine responsable for the suddenly triggered obsessions?

Answer
Hi . . .

While I have never seen an increase in obsessive symptoms in any of the 500+ patients I have treated with Lamictal, I did find the report below.

Best regards . . .
Ivan
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CNS Spectr. 2007 Feb;12(2):106-11.

An association of intrusive, repetitive phrases with lamotrigine treatment in bipolar II disorder.

Kemp DE, Gilmer WS, Fleck J, Dago PL.

Bipolar Disorder Research Center, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA. kemp.david@gmail.com

INTRODUCTION: Bipolar disorder is frequently associated with obsessional symptoms. However, no reports have identified a pattern of obsessionality that is associated with a specific mood stabilizer treatment. METHODS: A chart review was conducted on five patients with bipolar II disorder who spontaneously reported a form of obsessionality characterized by intrusive, recurrent phrases after taking lamotrigine. RESULTS: Development of the phrases occurred from 7-42 years after mood disorder onset and occurred only after initiation of lamotrigine treatment. The phrases improved with lamotrigine discontinuation or dose reduction and recurred with lamotrigine re-challenge or upon dose escalation. CONCLUSION: A possible mechanism for the development of the intrusive phrases involves the
influence of lamotrigine on glutamatergic regulation in a bipolar II disorder population vulnerable to the expression of obsessionality. Limitations of this report include its observational nature, small number of cases reported, and
confound of concomitant medication use.

Publication Types:
   Case Reports

PMID: 17277710 [PubMed - indexed for MEDLINE]