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Dr. Vikas
Dr. Vikas, Psychiatrist
Category: Mental Health
Satisfied Customers: 2253
Experience:  MBBS ; M.D Psychiatry, MS. Health Informatics
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My 19 year old son was diagnosed bipolar, obsessive, and

Customer Question

My 19 year old son was diagnosed bipolar, obsessive, and depressed. He is now at college and takes his meds but we are thinking he needs to change them or get a second (or forth really opinion). He cannot take ssris, is on 600mg lithium and 10 mg abilify because and earlier stint with 900 mg lithium and geodon left him exhausted, moving roboticly, and zombie-like. He remains depressed- much because of his reduced energy and inability to do the things he used to do as an athlete. He also is very restless and has a hard time sitting to study for more than 20 minutes at a time. last week he had 2 car accidents, he is slow to react, just not very attentive, easily distracted. I wonder if abilify is right or if he needs an antidepressant despite the risk. is there a widely respected bipolar expert in the Washington DC area we could get a second opinion from? We like our doc, but question the effectiveness of treatment.
Submitted: 7 years ago.
Category: Mental Health
Expert:  Dr. Vikas replied 7 years ago.
Hello carzl,

I will not be able to provide you a doctor name from washington as I am not from US, but if you would like to discuss the problem, could you please tell that has he ever been put on Lamotrigine?

Customer: replied 7 years ago.
No he has not.

He has been obsessive since childhood. He was treated for depression starting 5 years ago and was most helped by lexapro. Other drugs left him very tired and unable to function mornings at school. He then was found to be unable to take SSRIs due to the what we were told was a mania incident and related common self destructive thoughts he had during a high speed traffic stop. His mom and I always thought he was just very obsessive, over reacting, and sometimes depressed. There were 2 psychs who thought he was not bipolar after getting to know him, but specialists said he was. Friends with experience say he needs to be treated for depression. Since January he has been on lithium, prescribed 900 mg but takes 600 to reduce side effects. He took geodon, and it was very rough on him- he was like a zombie and walked like a robot and slept all the time.

Expert:  Dr. Vikas replied 7 years ago.
Thanks for the information carlz.

If he has been diagnosed as a case of Bipolar affective disorder and is currently in depressive phase, Lamotrigine can be a first line treatment option for him. This drug is very effective in treating depressive phase of bipolar illness as seen clinically and is also effective in preventing both depressive as well as manic relapses.

In comparison to Lamotrigine, both Aripiprazole as well as Lithium are not a very good option to control the depressive phase of Bipolar disorder on the basis of my clinical experience.

Lamotrigine for treatment of bipolar depression

For treatment of OCD, since SSRIs can worsen or induce the mania another very good option could be Cognitive Behavioural Therapy (CBT) such as Exposure and Response Prevention (ERP) and Cognitive Therapy (CT).

In my view, you should discuss with his doctors about the use of Lamotrigine and CBT in his case.


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Customer: replied 7 years ago.

I appreciate your response. I am at work so will only check email a few times. Another question: He was found through blood tests to require 900mg for lithium to be theraputic. He only takes 600. We thought that it left him tired and robotic in movement. We might be wrong as it could be from other meds. Should we continue lithium, and if so should we increase to 900? I never thought he was very manic, but he was definately happier if he was. Now he doesnt seem to care about much of anything, including living.

Given that we have comunicated all this to his current doctor who saw him in the 2 week hospital stay, do you think she has responded well and prescribed well or should we seek another doctor locally? He used to be such a creative person and so athletic, not he is just tired and unhappy and restless.

Expert:  Dr. Vikas replied 7 years ago.
Thanks carlz.

You have mentioned that earlier he was on Geodon and Lithium, and both of them are very much sedative (Geodon much sedative in moderate to high doses in some patients) and this could be the reason why he was feeling so tired, exhaustive and zombie like.

May be because of this reason her doctor had replaced Geodon with Aripiprazole (abilify) which is not very sedating (alerting in some) and also reduced the doses of Lithium. (This is what I speculate). Abilify is also a very good drug and is now a days, doctors are also using it for bipolar depression and I think his doctor is competent enough and rational in her treatment.

In my view also dose of Lithium could be increase to the previous effective level for a trial if he is able to tolerate Lithium and remain symptom free.

Customer: replied 7 years ago.
Would you increase lithium for a short trial before considering lamotrigine? He, not his Doctor wanted to reduce the dose of Lithium. Is Lamotrigine a substitute for Lithium, or is it for Abilify, or both, and could this reduce his negative side effects?
Expert:  Dr. Vikas replied 7 years ago.
Carlz, in my view dose of Lithium could be raised to the previous effective one, and Lamotrigine can be a substitute for abilify. It is too early to comment on that 'will it reduce the negative side effects' but this combination of Lithium and Lamotrigine could be a useful one if he is not responding to the combination of Lithium and abilify.

A placebo-controlled 18-month trial of lamotrigine and lithium maintenance treatment in recently manic or hypomanic patients with bipolar I disorder.

Best wishes,
Dr. Vikas and other Mental Health Specialists are ready to help you
Customer: replied 7 years ago.
Your input has been very helpful. I appreciate your service, as I have been contemplating the isssues for a long time,but had no easy place to get the answers I needed. I will go back to our regular doctor with the info you provided and seek her conclusions. Thanks.
Expert:  Dr. Vikas replied 7 years ago.
You are most welcome carzl. Thanks for coming to JA.

I wish your son a very early and speedy recovery.

Best wishes