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Dr. Kaushik
Dr. Kaushik, Psychiatrist
Category: Mental Health
Satisfied Customers: 4485
Experience:  MD Psychiatry
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Flat affect and what to do about it?

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BP II (diagnosed last year after previous diagnosis of depression) I take Lithium, Lamictal, low dose Seroquel (helps with sleep and anxiety). Feeling flat - mornings are the worst and I can find it quite difficult to get motivated. Frustrating as I'm normally a quite active person. I'm not sure if this is from medication or if it will pass. The dead inside feeling is a real challenge.

Greetings !

Welcome to the site.

I am Dr. Kaushik and i am a psychiatrist and i believe i can help you with your problem.

Well you see the flat mood that you are struggling with as of now is a part of Bipolar depression aka depressive phase which is usually episodic in occurrence lasting several weeks to months in a Bipolar 1 or Bipolar 2 patient before a switch to either normalcy or hypomanic or manic episode shall take place.

I can understand the limitation of not using anti depressant or mood elevating drugs like modafinil in your condition as they may precipitate manic/ hypomanic episode thereby compromising your treatment so with this sort of restriction with the drug use to counter this depressive phase you can try some supplements such as Omega 3 fatty acids or Ginkgo biloba or combination of both to help passing this phase which is going to self limit or resolve itself in due time as is typically seen in bipolar disorder.

Other than trying supplements and patiently waiting to come out of the depressive phase one other very effective treatment option is available and that is called as TMS therapy that is Transcranial Magnetic Stimulation therapy which is a non-invasive treatment modality basically used to treat clinical depression but it can very well be applied in your case since drugs like anti depressants are not an option and it shall help you to overcome this depressive cognition.

In this TMS therapy an electromagnetic field is created over the head via TMS machine which then is used to stimulate areas of brain so as to treat depression.

I am sending below a link which you can go through to know more about TMS.

So to summarize if you can combine the present drug regime + omega fatty acids and ginkgo biloba + CBT + TMS therapy then you may find effective and faster remedy for your depressive cognition.

I hope this helps.

Wish you all the best.

Please kindly leave a Positive rating if you are satisfied with the answer.

If there is any further assistance needed please feel free to ask using the reply button.

Dr. Kaushik and other Mental Health Specialists are ready to help you
Customer: replied 3 years ago.

Thank you Dr Kaushik - I'm glad you said this phase will pass as I don't want to feel this way forever. The mood stabilisers do their job - I'm not high and I'm not crying and thinking about death - my Dr said euthymic - I said no 'flat'. I guess I'm euthymic in comparison to how I was a few months ago when I was put on to Lithium. I can understand that the flatness is probably related to a depressive phase - I look forward to normalcy Smile


I take Omega 3 fatty acids but was wondering if the Ginkgo biloba would interact with any of my other medications? Thank you for the TMS information - I'm not sure where in NSW TMS is available but I will ask my Dr.




NO, Ginkgo biloba will not interact with any of your drugs and being a herbal drug it is quite safe so you shall start taking it.

Wish you all the best.


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