For treating Bipolar depression, Lamotrigine is the preferred choice. It is not an antidepressant but a mood stabilize / antiepilectic which is specially useful in treating depressive phase of Bipolar illness. It also prevents future manic or depressive phase of Bipolar illness.
But it will not be very useful in controlling anxiety.
Regarding antidepressant, either Desvenlafaxine / Venlafaxine or Bupropion can be a useful options for controlling the depressive symptoms.
Again here, Bupropion will not control the anxiety symptoms but can be useful in ADHD symptoms.
Venlafaxine / Desvenlafaxine can control both anxiety and depressive symptoms.effectively.
Benzodiazepines like Clonazepam (Klonopin) are also the very good alternative for controlling anxiety symptoms but can be taken for short durations (8-12 weeks) or on as and when needed basis.
If he has occasional anxiety symptoms then Clonazepam is a better option to be taken on as and when needed basis.
I hope this helps, please feel free to discuss further if you have any other query.
Are you in the UK?
Are you saying substitute Lamotrigine for Serequel or Abilify?
Klonipin/anxiety meds is not best option for anxiety because he has had problems abusing this type of meds.
What would your med mix be for
The reaons I ask if you are in the UK is because Venlafaxine - I believe here is called Pristiq. I only know name brands because I have been on anti-depressants myself and had them all for many years.
I know you don't know his weight, height etc. but he is 220 and 6'1". Just give me what you might prescribe if you were his physician and I will discuss the posibilities with his physician.
Just an idea of a daily regimen - not exact measurement etc. - since this is by email.
Thanks for your reply.
I am not from U.K :).
Lamotrigine can be added by his doctor in combination with Seroquel or Abilify. In my view, there is not much senses in using Seroquel and Abilify together ( both atypical antipsychotic).
Instead of this combination, either Lamotrigine with Abilify or Lamotrigine with Seroqul (Mood stabilizer + atypical antipsychotic) is a much better option for Bipolar disorder.
If I am correct, Wellbutrin (Bupropion) is not approved in UK for depression and is available only for smoking cessation. In that case, either Desvenlafaxine (Pristiq) or Venlafaxine (Effexor) can be tried for depression and anxiety symptoms.
So to summarize, if his doctor want to continue the combination of Abilify + Seroquel, an antidepressant like Pristiq can be added to control his anxiety and depression symptoms. The dose of Pristiq is 50 mg per day in a single OD dose.
Since you have ruled out the possibility of using Klonopin therefore to control anxiety symptoms, adding an antidepressant like Pristiq or Effexor is the reasonable choice.
Please feel free to discuss further if you have any other doubts.