Hello doctor, I have bipolar disorder II and diagnosed with social and generalized anxiety disorders. Currently, my medication fails to uplift my depression. I take lithium 3x450 mg, Olanzapine 5 mg, Escitalopram 20 mg. Previously I tried Valproic acid, Carbamazepine, Topiramate, Zoloft, Prozac, Clonazepam, Tranxene, Rudotel, and Lexotanil. I experience more depressive episodes than hypomanic. And I cannot take Lithium anymore due to kidney damage done. What are my treatment options? We are considering changing to Lamictal, and a small dose of Wellbutrin. What do you think about this?
Hello,  Welcome to icliniq.com. Yes, bipolar depression is difficult to treat and it can be persistent. Many people do respond to a combination of Lamotrigine and Quetiapine (popularly called as Lami-quel). It takes time to act, but it is highly effective. Currently, I would suggest that instead of Lithium you use Lamotrigine 25 mg x 2, then 50 mg x 2 and finally 100 mg x 2. Dose titration is every two to three weeks. Instead of Olanzapine, I would replace it with Quetiapine 50 to 100 mg for start and raise if needed based on the sedation. Also, continue Escitalopram if needed or replace it with a TCA (tricyclic antidepressant) class of antidepressants. And yes, do add Bupropion (Wellbutrin). Also, you can consider doing a few sessions of rTMS (repetitive transcranial magnetic stimulation) if possible.