Thanks for the follow up and telling me about her condition.
I am really very happy to know that she is now improving and responding well to her medicines. This is indeed a very good news :)
Now regarding her medicines, Lithium and Lamotrigine are indeed a good choice for Bipolar disorder but I personally don't use Lithium frequently in children because younger children tend to have more frequent side effects and should be monitored more frequently while on Lithium.
Lamotrigine is also a good choice as a mood stabilizer but it is used in children primarily for Lennox-Gastaut syndrome which is a seizure disorder. Using it as an mood stabilizer in children will be an off-label use. It is not known if LAMICTAL is safe or effective in children or teenagers under the age of 18 with mood disorders such as bipolar disorder or depression.
Regarding the use of Abilify in children -
"Abilify was recently approved for the acute treatment of manic and mixed episodes associated with Bipolar I Disorder with or without psychotic features in pediatric patients (aged 10-17), in February 2008.
The FDA approval was specifically for maintenance treatment of manic or mixed episodes, and as add
-on treatment to lithium or valproate, for children ages 10 to 17 who have Bipolar I Disorder, the more severe type of bipolar disorder. "source
As your daughter is responding well to a very low dose of this medicine therefore in my view continuing Abilify could be a better option instead of shifting her on Lithium and Lamotrigine. If her doctor think that she is paranoid, in that case again an atypical antipsychotic like Abilify will be a better option than Lamotrigine or Lithium because Lithium or Lamotrigine are not useful for treating paranoid symptoms.
If required, the dose of Abilify can be increased later by her doctor.
In case of worsening of her symptoms, a combination of Aripiprazole with Lamotrigine if required at all will by my first choice instead of combining Lithium with Lamotrigine.
Having said this, her doctor is the best judge here regarding medicines as he or she exactly knows about her clinical condition but still in my view, You should discuss with her doctor about these options mentioned below also before shifting her on Lithium and Lamotrigine
- further increasing the dose of Abilify
- using combination of abilify with Lamotrigine if required at all.