Q:  Anti-depressants & Rheumatoid Arthritis

Dear Dr. Phelps,

I have bipolar disorder but also rheumatoid arthritis.  I am taking Tegretol as a mood stablizer and lorazepam and clonazepam for sleep.  My question is that any anti-depressants I take make my RA flare and my doctor has me on Lamictal and that also has caused my RA to flare (3 times at least at over 50 mg., under 100 it does no good).  Have you ever encountered anyone with RA who has had the same problem?

Many thanks,


Dear Ms. B' -- 
I have several patients with this combination of rheumatoid arthritis and some bipolar variation. Off the top of my head, I can't think of any reaction they might have had to lamotrigine (one in particular has such severe symptoms and reactions to medications, I don't think I would have been able to associate lamotrigine as causing a worsening, though we have tried it). Sounds like you're wondering how you might go about treating a part of the problem, namely depression. For that, you'd want to make sure you had reviewed the options from a list of "antidepressants that aren't antidepressants", if you will.  Take that link for such a list. 

Dr. Phelps

Published October, 2005