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Suggest treatment for depression despite taking Lithium and Wellbutrin

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Posted on Thu, 26 Oct 2017
Question:      My 26 yr old son was depressed at the beginning of th year and was prescribed prozac. This precipitated manic episode from mar-jun, during which he was taken off prozac, put on lithium (450) mg, then fell into a severe depression. He was then put on wellbutrin (past 4 weeks) but depression seems to be worsening. altho he has a psychiatrist and a therapist, he is low-functioning and desperate. I am bipolar II myself and have been trying to help him through this but he seems stuck. My question is what else can we do to help him? We are both afraid. XXXXXXX YYYY@YYYY
doctor
Answered by Dr. Ashok Kumar (1 hour later)
Brief Answer:
I think there is need to change medications

Detailed Answer:
Dear XXXXXXX
Thanks for using Healthcaremagic.

I read your query and understand your concerns.

First of all I like to inform you that there is no doubt about the diagnosis and your son should be treated as a case of bipolar depression rather than simple depression.

Secondly wellbutrin is not an approved medication for treatment of bipolar depression. Secondly considering the development of mania with use of prozac in past clearly indicates that antidepressant alone should be avoided at any cost.

Regarding the treatment of choice olanzapine fluoxetine combination (OFC) should be used as medication for the treatment of bipolar depression. Same need to be discussed with treating psychiatrist as you will need prescription to buy it for your son. My recommendation is based on the fact that prozac had good mood lifting effect on your son in January 2017 and same can be expected under the cover of mood stabilizer medication such as Olanzapine.

In addition to medications there is need to engage in some or other activities. I understand it is very difficult when someone is depressed but it is not impossible.

I hope this helps you.
Feel free to write back to me if you have more questions.
Thanks and regards.
Above answer was peer-reviewed by : Dr. Vaishalee Punj
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Follow up: Dr. Ashok Kumar (1 hour later)
thank you so much! I had ignored ssri treatment for him because of the manic response, but I did not do the research on OFC (until now). Will be bringing it up forcefully with his psychiatrist this week. He's seeing a CBT therapist an is desperate to get activated, but his level of misery is so high it is hard. Was hoping the wellbutrin would bring him up enough to help, but now I think we would be waiting forever for a very bad outcome. Thank you for giving us hope and an alternative. and I imagine when I tell him he could be taking prozac again, I might get a small smile.
XXXXXXX
doctor
Answered by Dr. Ashok Kumar (17 minutes later)
Brief Answer:
Thanks for your feedback

Detailed Answer:
Dear XXXXXXX
Thanks for follow up and lovely feedback.

Personally speaking I rarely found the wellbutrin helpful in individuals with bipolar depression and that was the another reason I feel wellbutrin is not a great option for your son as we are dealing with bipolar depression.

I hope this helps you further.
If you have any further query, I would be glad to help you.
If not, you may close the discussion and if possible you may rate the answer for my future patients.
In future if you wish to contact me directly, you can use the below mentioned link:
http://doctor.healthcaremagic.com/doctors/dr-ashok-kumar/67386
Thanks and regards.
Above answer was peer-reviewed by : Dr. Vaishalee Punj
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Answered by
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Dr. Ashok Kumar

Psychiatrist

Practicing since :2000

Answered : 3163 Questions

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Suggest treatment for depression despite taking Lithium and Wellbutrin

Brief Answer: I think there is need to change medications Detailed Answer: Dear XXXXXXX Thanks for using Healthcaremagic. I read your query and understand your concerns. First of all I like to inform you that there is no doubt about the diagnosis and your son should be treated as a case of bipolar depression rather than simple depression. Secondly wellbutrin is not an approved medication for treatment of bipolar depression. Secondly considering the development of mania with use of prozac in past clearly indicates that antidepressant alone should be avoided at any cost. Regarding the treatment of choice olanzapine fluoxetine combination (OFC) should be used as medication for the treatment of bipolar depression. Same need to be discussed with treating psychiatrist as you will need prescription to buy it for your son. My recommendation is based on the fact that prozac had good mood lifting effect on your son in January 2017 and same can be expected under the cover of mood stabilizer medication such as Olanzapine. In addition to medications there is need to engage in some or other activities. I understand it is very difficult when someone is depressed but it is not impossible. I hope this helps you. Feel free to write back to me if you have more questions. Thanks and regards.