Hi

1st thing if he has manic episode then it is not bipolar 2.
depression with manic episode is bipolar 1.

For manic episode in bipolar lithium is the choice.
Lithium even work in depressive phase of bipolar disorder.

Now a days US FDA approved quitipine in bipolar depression which has good results.

But choice of mood stabilizer is depend upon his clinical presentation and detail history.
your psychiatrist know everything about patient then he will best guide you
Thank you.

In my opinion, if the patient is highly concerned about wight gain, and there is no significant effect with lamictal, lithium carbonate would be a good option. However, you must discuss the other options available (carbamazepine, oxcarbazepine and second generation antipsychotics) with the treating psychiatrist.

hi..your family member is diagnosed as bipolar disorder type 2 that is bipolar depression. he is taking celexa that is citalopram, a SSRI antidepressant, along with lamotrigine 125 mg. as per your concern mania episodes are not under control, i want to tell you that person diagnosed with bipolar depression does not have severe manic episodes otherwise diagnosis would have changed. if there is severe manic symptoms and for that lamotrigine wont work, u have to start depakote for the control of mania and shud stop antidepressant meds.

along with depakote u need to give an antipsychotic medication to control the agitated behavior if present. u can give risperidone 2mg twice daily, olanzapine 5 mg twice daily..but these antipsychotics u need to stop aftr mania is under control and patient can be managed on depakote only.

if it is bipolar 2 disorder than u shud increase the dosage of lamictal to upto 300 mg to 400 mg per day in a divided dosages.
even after he has no improvement then u shud stop both of these meds and start him on combination tablet fostera [10] which contains both fluxetins and olanzapine, it approved by US FDA for bipolar depression..

another option is to give him quetiapine [200] mg at night and gradually increase the dosage as per response upto 400 to 600 mg per day..

depakote and olanzapine can increase weight significantly..other drugs are somewhat safe..

best luck..