Brief Answer:
Prioritize resolution of depressive symptoms

Detailed Answer:
Hi XXXX,

Thanks for writing to us,

I went through the history provided by you. Bipolar disorder can present in the form of depressive episode. It is a part of the same illness. Depressive episodes usually last longer but the duration can be reduced with treatment. In bipolar disorder, antidepressant medications like Lexapro or Escitalopram is not given alone, it is prescribed under the cover of a mood-stabilizer, like Sodium Valproate, Lithium, oxcarbazepine etc to avoid switching of mood symptoms. All the available mood stabilizers have serious side effects because of which it is chosen carefully according to patient profile.

Seroquel (Quetiapine) is one of the drugs approved in Bipolar Depression. It is an effective drug to manage symptoms of depression. Unfortunately it is not completely free of side effects of weight gain. The dose of 150mg/day however, is not sufficient in most cases. Dosage would have to be increased for resolution of symptoms. In situations like this, it becomes necessary to weigh the benefits of the drug versus the side effects. This has to be discussed with your doctor.

Abilify (Aripiprazole) is not known to cause any side effects of weight gain etc. It is quite a safe drug. But it is not effective alone for a depressive episode.

Unfortunately, there are no known natural treatments that are approved or effective in treating mood disorders.

If after increasing the dose of Quetiapine, symptoms do not resolve, a combination of Oxcarbazepine and an antidepressant like Sertraline, fluoxetine or paroxetine can be tried, if it has not already been tried earlier. Oxcarbazepine is not completely free of side effects but is relatively better. If one antidepressant causes certain side effects, others may not necessarily do the same.

Hope this helps,

Dr A Rao

---