Q:  Thoughts on Using Seroquel & Lamictal Together?  What are Recommended Dosages?

What are your thoughts on using Seroquel and Lamictal together?? What are your recommended dosages for both? 

The Patient is a 75 year old woman with DX of Dementia and Bipolar disorder She has manic episodes and can not maintain control screaming demanding impulsive a danger to herself and a fall risk etc. 

Thank you
G          
 

Dear Ms. G’ –

The starting place, in attempting to answer a question about a 75-year-old woman with dementia and bipolar disorder, is an extremely thorough assessment of the patient's past history and current symptoms.  As I cannot do that step, I will turn directly to your question. Seroquel and Lamictal can easily be used together.  If lamotrigine was first and Seroquel was then added, one must always ask whether Seroquel alone might be providing enough antidepressant effect, which it has on its own, to do without the Lamictal. As you know, in older folks, medications can multiply like rabbits. 

As for dosages, one certainly must begin with the old adage "start low and go slow".  Don't forget to keep Depakote on the list of options.  It is generally very well tolerated in elderly people, and is another candidate which can address both agitation and manic-side symptoms (in general I would prefer it to Seroquel as it is less sedating overall, a major concern in the elderly; and prefer it to lamotrigine as well, because the latter generally would be less reliable for treating agitation, although it might work. 

Just some ideas for you to review with the treating physician --
 

Dr. Phelps