Lamictal & Suicidal
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Q:  Lamictal & Suicidal

I was diagnosed as a BP about 3 months ago.  It's been difficult.  My physician prescribed Lamital but I don't believe that it is working. The rages are still there. The crying all the time is still there. The need to spend money all the time is still there.

I have been in therapy since 1999. I was diagnosed with BPD and severe depression. It seems that nothing has worked for me. I still feel the emptiness and suicidal. Can you give me any suggestions as to what else or if there is another medication that will help me. I am desparate and I know that if I can't find anything else to work for me, I might not be around much longer.

Best Regards,

Dear Karen --
Wow, this sounds awful. It's like "hurry up" time. As you have experienced, lamotrigine is slow to get going so if it doesn't work, you're stuck with symptoms for quite a while. Fortunately, there are alternatives that are much faster. Unfortunately, some of them have more potential for side effects (perhaps that's how you and your doc' decided on lamotrigine).

You need to look at the full list of "mood stabilizer" options, of which (if I understand you correctly) you've only had one so far, and there are at least 4 or so more, depending on how you count. See that link for my version of the "menu". Which one should you try next? That's hard to say without knowing your symptom pattern and a bunch of other details. If you haven't done this already, try reviewing that list with your doctor, looking at side effect risks.

Here are the symptoms that stick out, to my ear, suggesting that a solid "anti-manic-side" mood stabilizer is what you need (at least right now): rages; crying all the time [sometimes called "lability" or a "labile mood", meaning just a little bump, or even a television commercial or something, can make you cry]; need to spend money all the time; desperate [depression alone is less likely to produce "desperate"]. The "emptiness" part might even warrant learning about "borderline" and bipolar, but not necessarily.

As you will learn, lamotrigine may not be the best "anti-manic-side" medication on the menu. Your doctor might have picked it, perhaps, because it is one of the best "low-side-effect-problems" on the list?

Check out the fish oil story as well while you're there looking at the menu (it's under omega-3 fatty acids in the table on the mood stabilizer page). Maybe no risk at all; pretty cheap; helps with depression as well as acting as a mood stabilizer? But all of those are "maybe's", as you'll see, because all the research studies so far are pretty small. And if anything, fish oil is in just about the same "niche" as lamotrigine (maybe a better antidepressant than an anti-manic? ; few side effect risks; and takes a long time to see if it is helping).

Finally, if it gets to the point where you're having pretty serious thinking about suicide, you need to go to the emergency room if you can't reach your doctor directly. And long before then you should make sure that she knows that you're thinking like this, okay. There are some nice resources about suicide on the 'net, like this one, but safety comes from making sure the folks in your safety net know what's up with you. Good luck to you.

Dr. Phelps

Published January, 2004


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