Q:  What Meds to Try Next

I am a 44 year old woman diagnosed with bi-polar II- in my lifetime have had several other diagnoses but I think my symptoms and ability to function are more important. I was working successfully in a high stress management job when my boss and friends noted increased agitation and hypomania. Seven years ago was on disability for over a year. I went to a psychiatrist and was placed on Depakote ER with gradual increases to 2000mg daily, after 1 week noted I was much nicer but increasing depression- placed on Wellbutrin SR 100mg daily and Ativan 1 mg PRN. Essentially had a breakdown at work where I couldn't put thoughts together-I have been on leave now and my psychiatrist is trying to find the meds so I can return to work. Wellbutrin has been increased to twice daily, tried Zyprexa but that made me very agitated. My major symptoms now are depression, but mainly rumination and paranoia. As a child I was sensitive to the old neuroleptics causing EPS symptoms. Do you have any suggestions?  Thanks in advance for your help. Feel free to edit.

Dear Nancy -- 
You're far enough down the road that diagnosis isn't too critical anymore; what med' change you'll try next may be the question, as I think you've gathered.  Have you had a trial of mood stabilizers, maybe more than one, without antidepressants on board?  I think that's getting to be pretty accepted as a useful thing to try for folks with a history like yours.  Ask your doc' about that.  Read my website, treatment details section under BPII, for other ideas. 

Dr. Phelps

Published June, 2001