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Irritability and aggression after taking Seroquel for Bipolar disorder. Due to drug interaction between Lithium, Lamictal and Seroquel?

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Practicing since : 2004
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My son was taking 600mg lithium, 200 mg lamictal. This was decreased to 450 mg lithium, 150 mg of lamictal, and the doctor added 150 mg of seroquel yesterday. My son could not function today when the seroquel was added. So sedated and sleepy. Should we drop the seroquel or decrease it? He has finals to study for. He had been having additionanl irritability and aggressiveness; that is why the doctor added the seroquel.
Posted Wed, 25 Apr 2012 in Medicines and Side Effects
Follow-up: Irritability and aggression after taking Seroquel for Bipolar disorder. Due to drug interaction between Lithium, Lamictal and Seroquel? 2 minutes later
Does an increase in lamictal cause mania/ and that is why seroquel is added?
Answered by Dr. Ashish Mittal 6 hours later

Thanks for your query.

I appreciate your efforts for medical consultation in so much distress.

Important aspects of your query are:
•     16 year old male
•     Known case of Bipolar disorder
•     Currently on: 450 mg Lithium, 150 Lamictal (Lamotrigine) and 150 mg Seroquel (Quetiapine)
•     Concern related to excessive sedation with medicine.

Following medicines are well researched and found to be effective for Bipolar disorder: Lithium, Depakote (Valproate), Lamictal (Lamotrigine) and Carbamazepine. These medicines also called as mood stabilizers.

Out of these medicines, patients get stabilized on one or combination of two medicines. Choice of medicine is dependent on patient illness state (which can be assessed on interview only), side effect profile of medicine, and duration of illness, weight, age and sex of the patient. Sometime other antimanic agent (like seroquel) needs to be added depending on the severity of episode.

Seroquel is associated with sedation which is sometime necessary considering aggressive symptoms in manic patients. If it is problematic then it should be started on low dose. Apart from that lithium needs to given in adequate doses to maintain serum lithium level 0.6 to 1.2 mmol per litre. But all these decision need to taken after blood investigation for lithium and mental status examination of patient.

I hope this information has been both informative and helpful for you. In case of any doubt, I will be available for follow ups.

Wish you good health.
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