My 21-year old daughter is diagnosed with Bipolar II. After being on Welbutrin and Lamictal, for awhile and doing well, she thought she was okay and decided to stop her medications. She relapsed, and the meds didn’t work as well when she went back on them. So Prozac and Lamictal were tried I believe, then Cymbalta – neither seemed to help. Now a new psychiatrist is prescribing the extended release form of lithium. So far not getting any results, but not up to therapeutic dose yet. While I understand the good things about lithium, I have a few concerns/questions about it:
- Since she is so young, and lithium appears to affect the body for the worse, possibly, over a long period of taking it, wouldn’t it be better to try some of the many other drugs that are out there?
- Because she is Bipolar II and the hypomania is not as bad as the depression, couldn’t there be some other combination that could possibly work?
- If the lithium doesn’t work – which this Dr. says it doesn’t in 2/3 of people, what will be her options for medication after that?
Thank you so much – any light you can shed would be appreciated.
Dr. Fink Answers…
Before I answer your questions, you mention something that’s an important reminder for many people who are being treated for bipolar disorder: When you stop taking medications that work, they may not work as well when you decide to go back on them. Consult your prescribing doctor before going off any medications. To answer your questions:
- Lithium is first-line medication for treating bipolar disorder and is one of the few medications for bipolar that treats both poles – the mania and depression. All medications carry some risks. As long as your daughter’s lithium levels are carefully monitored, and thyroid and kidney function are followed regularly, lithium is a relatively safe medication and a pretty good first choice for many people.
- Many other combinations of medication could work, but that is for your daughter and her doctor to decide. Treating the depression pole of bipolar is not easy. It sounds as though her doctor is taking the right approach by starting your daughter on a mood stabilizer that has antidepressant properties. If this doesn’t work, the doctor can then add an antidepressant with less risk of causing a shift to mania.
- Remain positive, hope the lithium works, and deal with the possibility of it not working if and when that occurs – in other words, cross that bridge when you come to it. If the lithium does not work, numerous other options are available, and your daughter’s doctor can help in identifying the options and discussing the risk/benefit profile of the various options.