Suggest Treatment For Depression

Posted on Thu, 30 Oct 2014

Question: Hello. I was diagnosed Bipolar 10 years ago. Have had many ups and downs.
Now I am taking 600 mgs / Lithium Carb.(AM) and 20 mgs Fluoxetine (PM).

I am very, very depressed. With all the usual symptoms. I live and work in Saudi Arabia currently (rural) without access to a decent psychiatrist. I am desperately trying to get out of this depression. Should I adjust the aforementioned meds?

Thank you.

Answered by Dr. Vipul Prajapati (8 minutes later)

Brief Answer:
Details required

Detailed Answer:
Hi dear,

Thank you for the query.

Since when are you on this combination of Lithium and Fluoxetine?

Since when you are having depression?

Is there any reason behind relapse of depression like irregular medication, any stress, any medical illness etc..?

Lithium is good for Bipolar disorder but as you mentioned that you are having many ups and downs in past so I would like to suggest you to take Lamotrigine 25 mg initially after discussing with your doctor, which has good effect particularly in Bipolar depression.

Also there are many medication for Bipolar depression like Olanzepine, Quitiapine etc...

Awaiting your response.

Thank you

Above answer was peer-reviewed by : Dr. Ashwin Bhandari

Follow up: Dr. Vipul Prajapati (24 minutes later)

Thank you for your reply doctor,

Yes, I have had some irregularities with meds.

The timeline (up to now) is this:

1.5 years ago --- (Lithium + Fluox) for one year.
8 months ago --- (Lithium only) for 6 months.
7 weeks ago--- (Lithium + Fluox) up to now.

This depression cycle started about 8 weeks ago. That is why I re-started the Fluox, hoping it would help. But, in the last 3-4 weeks the depression has continued going lower and lower. Now, it is at a dangerous level.

I had many ups and downs over the years because of trying to adjust to medication, being reckless and alcohol and marijuana abuse problems. I can say that alcohol / illicit drugs are NOT a factor now.

I'm eating ok....pretty healthy.

My biggest problems are rumination, worry and anxiety.

It's strongest in the morning and tapers off at night.

It's starting to affect my sleep patterns.

Please doctor, understand. I am alone in this. This is my fight and I have experience, so I know I can win.

I just need some practical advice about the meds I have with me.
Finding a psychiatrist in this region of Saudi Arabia is not possible.

Please inform me if I should change 600mg Lithium / 20mg Fluox to something higher or lower(?)

Please doctor, in your educated opinion. This is the only medicine I have to work with right now. In Saudi, doctor's visits are not confidential and I'd lose my position for seeking out a psychiatrist. I understand that, that might mean I can't stay here. But, I want to try to fix this first.

Thank you.

Answered by Dr. Vipul Prajapati (7 minutes later)

Brief Answer:
Need to increase the dose.

Detailed Answer:
Hi dear,

I understand your concern but as I have not examined you physically, it would not be possible to prescribe you any medications nor can advise you to change the dose of any medication. I can only say that in your case with Fluoxetine up to 40mg and Lithium up to 900mg can be raised for highest effect but only under a doctor's guidance as these drugs may have lethal effects.

But once you are stable with medication don't change dose of medication and take it regularly as Bipolar illness is chronic illness and there are many chances of relapse.

So, I advise you to see a Psychiatrist.

Avoid any kind of substance abuse like alcohol, marijuana etc...

Do exercise regularly which also helps you to improve your depression.

Thank you

Note: For further guidance on mental health, Click here.

Above answer was peer-reviewed by : Dr. Ashwin Bhandari