Concerned about Mother's Depression & Meds
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Q:  Concerned about Mother's Depression & Meds

My mother, diagnosed with Bipolar II, is under the care of a  psychiatrist, who prescribed traditional antidepressants for her with disastrous results & side effects.  I offered him studies which contra-indicated antidepressants for most people with Bipolar II, whereby he took her off Zoloft and prescribed Lamictil with Seroquel prn.  Four months passed but 80% of the time she was depressed.  He then added Depakote, but because she was so sleepy, dc'd the Lamictil leaving her on only Depakote and Seroquel prn.  She has gone even more downhill in the succeeding weeks, to the point that I am afraid her spirit will just say, "enough!" and she will fail to thrive.  She is suffering immensely, in bed much of the time depressed and anxious.  Isn't another medication missing in her regimen? 

Dear Ms. B' -- 
Hard for me to comment here without sounding like I'm criticizing the treatment prescribed by another psychiatrist, when he knows the patient and I do not. On the other hand, it sounds like you are pretty sure there's something wrong with the current approach. So I'm going to focus on your concerns, not on your mother's treatment. You are worried she needs more antidepressant "clout"? Some recent data suggests that Depakote can have an antidepressant effect
Davis ; but generally doctors would think, for this role, of lamotrigine or Seroquel. The latter has very strong data supporting its efficacy in bipolar depression, the so-called BOLDER trials; and lamotrigine is a very common go-to agent for this purpose, sitting one notch higher on the Texas algorithm for bipolar depression than Seroquel, for example. The other agent you'll see in that Texas list is lithium. 

Your mother's psychiatrist might be a bit overwhelmed by your input? He was open to your input at one point. But sounds like you might have to be cautious with suggestions based on your own learning: you may not be ready to drive the car, and he may be a bit lost when trying to use your map. I'm not so sure about that part; something to watch for.  Good luck with the process. 

Dr. Phelps

Published December, 2006

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