I have been diagnosed with something called mixed state bipolar II (something like that)

I have been hospitalized numerous times and was finally stabilized for a few years on Nardil (MAOI) after having ECT treatments (at age 24).  The ECT was very effective and the MAOI worked for awhile.

Now my doctor has suggested a combination of Lamictal (which I have been on for about 3 months) and 5mg per day of Dexedrine.  How common is it to use a direct stimulant to treat mixed state/rapid cycling bipolar?  How effective is it?

(I used to use numerous stimulants (self prescribed!) and am now in 12 step recovery.  However, I am willing to do anything to feel normal but I do not want to have to undergo ECT or hospitalization again...  KL.

Dear KL -- 

Lamictal can be pretty great sometimes.  I've not heard of using Dexedrine for bipolar symptoms.  Some think there might be some risk of the stimulant having a destabilizing effect, in fact (e.g. particularly in kids where it's being used for ADD).  So at minimum I would think you would want to get up to speed on the lamictal first, unless your symptoms demand treatment faster (it's pretty slow to get going).  In that case, perhaps your doc' is trying to buy time with the stimulant as an antidepressant, and thus avoid antidepressants per se, which are clearly destabilizing, particularly for folks with "mixed state" symptoms.  Or perhaps she/he is trying to treat ADD-like symptoms?  

I hope you get a great response to lamotrigine, as many have.  Just be careful not to go up too fast and get the rash -- then you'd never be able to take it! 

Dr. Phelps


Published April, 2001