I have bipolar 2 and was diagnosed 6 years ago and started on lamictal and welbutrin sr.  I did fairly well on them but was at times very irritable. Then in 2005 I was diagnosed with auto immune hepatitis and because of the hepatic dosing for lamictal I could not take a large dose and eventually went off it all together with just the wellbutrin left. I also took prednisone of 50 mg a day to help my liver and gained 90 lbs. now am off the prednisone. My husband said my depression was coming back very much and I was crying all the time over everything. So he started me on celexa and now I feel happier but am cycling into horribly irritable moods with paranoia of my husband leaving me or having an affair even though in sane times i know that this should never cross my mind. I have also gained 25 lbs in the three months I have been on celexa and am now 275. Can you suggest anything my liver doc says that I have to lose a lot of weight to protect my liver? I have been reading about topamax and I know you don't really like it but if it could help  me lose weight and could work as well as the welbutrin and help with the horrible migraines I seem to get a lot right before an irritable cycle but what about my liver? My lft's are normal now and have been for the last year..


Dear Nora --

Not sure why, but as you may well understand you are "off the map" as regards the usual medication approaches to bipolar II. Generally we rely on "mood stabilizers". There are several of these, of which you have had one (lamotrigine). Others include carbamazepine or oxcarbazepine (not associated with weight gain), lithium, and valproate (Depakote). Seroquel has evidence for good results in bipolar II as well, but is associated with a risk of weight gain. Aripiprazole is not so well established in terms of long-term effectiveness, based on a combination of research and clinical experience, because it is newer; but it has less of a weight gain risk than Seroquel.

You and your physician (your husband?) May have good reasons for taking the approach you have described, in which case those from whom you seek advice will need to have the details necessary to understand that decision. Otherwise, I think most mood specialists would be wanting to help you get "on the map" so as to be able to navigate by known landmarks.

Dr. Phelps



Published May, 2008