Asked Pdocs About Selegiline,Lamotrigine...
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Q:  Asked Pdocs About Selegiline, Lamotrigine...

I am a 57 year old male first diagnosed with "Unipolar Depression" at age 18. I have been through ALL of the SSRI's, TCA's, Lithium and atypical neuroleptics,(all at high dose adaquate term, blood chem.OK)with miminal to no result or side affects and weight gain. Hospitalized 8 times (last two times near death do to prolonged benzo., amphetamine abuse), I was permenantly disabled 4 years ago.I have atypical symptoms, weight gain, reactive mood, hypersomnia, some past dillusion symptoms-anger.

You guessed it!! Two weeks ago a new doc. dx Bipolar II.(unfortunatly he is in research not taking pts). I am currently on Depkote, Zoloft, Wellbutrin, all started in passed 6 weeks. HERE IS THE PROBLEM: I have asked 2 different pdocs about Selegiline and or Lamotrigine to augment Depokote after proper "washout" of Wellbutrin & Zoloft. One yelled at me he wouldn't be involved, the other more politily refused. What is the matter with these people......don't they ever read a journal article? Thank you.

Dear Richard -- 
Our system of care has not organized itself to reinforce behaviors, by doctors, like reading journals.  It reinforces seeing patients (fast).  Lamotrigine?  well, maybe they're yelling because they think you've learned some but not enough, like they thought you don't know (probably do by now?) about the interaction between the two that makes the combo' tricky, though not contraindicated?  That thought comes to mind because you may be out ahead of even me (i.e. somebody who tries to stay very up to date on all options in bipolar disorder) with the selegiline idea -- for an antidepressant?  Haven't you had enough of those, though?  How about plain old basics: combinations of well-known mood stabilizers, with no antidepressant in the picture: augment Depakote with lithium; augment those with Trileptal (replacing Tegretol in that role).  If you get clearly better, try to take out one of them to keep the total number of medications down.  Start with basics first and exhaust them, because it sounds like that's not been done yet. 

Dr. Phelps

Published November, 2001


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