Darkeyes - Bipolar disorder is one sh***y thing to live with. Unfortunately, no matter how well controlled a person is with medication, or for how long, a breakthrough manic episode can occur. Seldom can it be stopped from happening. Docs will up the mood stabilizer dose for awhile, but this is more for the patient's psychological state moreso than for any good it will do.

Even if the person is taking an atypical antipsychotic like Risperdal (risperidone) or Zyprexa (olanzapine), an increase of dose does little to nothing. In most other disorders (eg. schizophrenia) the atypicals, and to greater extent, the conventional antipsychotics (eg. Haldol - haloperidol; Mellaril - thioridazine) at least make the person groggy. It seems that this is not the case for breakthrough manic episodes in bipolar disorder.

What we are doing by giving maintenance medication in bipolar disorder is (hopefully) decreasing the number of episodes one may experience in a lifetime. Fewer episodes means a decrease in the "kindling effect".

The kindling effect is the phenomenon where one episode "kindles" the next. That is, the next episode will come sooner, be more severe, and last longer than the previous one. By decreasing the number of manic episodes in a person's lifetime, the less of a chance there is for the kindling to occur.

In the days before effective medications for bipolar disorder, many sufferers ended up being institutionalized for their own safety. Families just could not take care of the person on their own. Can you imagine the guilt involved in this; watching your loved one just get worse and worse.

Anyway, all that you can do is hang in there, show this post to hubby (aren't husbands supposed to get on your nerves, anyway?), and ride out the storm. The episode should pass in 10 to 14 days (usually); then the lithium (you are still taking lithium, aren't you?) should begin to hold you, again.

The Lamictal (lamotrigine) mainly only works for the depressive part of the bipolar episode. I don't think that it does much for the mania. That is why they usually use the newer anticonvulsants (Neurontin - gabapentin; Topamax - topiramate; and Lamictal), although Topamax and Neurontin do seem to keep the manic episodes at bay in some people.

And yes, I have heard of "manic switch" (going from depression to mania) when adding Lamictal to the mix. It does not happen very commonly, especially when compared to traditional antidepressants. The tricyclic antidepressants (eg. Elavil - amitriptyline; Tofranil - imipramine) and the MAOIs (eg. Nardil - phenelzine; Parnate - tranylcypromine) are the worst offenders for manic switch, but this phenomenon has been seen with all antidepressants. Some researchers think that the antidepressant is relieving the depressive episode of the person with bipolar disorder, but in doing so, the mania that was being kept in check by the depression no longer comes rushing out. This is only a theory, and does not apply to all cases of manic switch.

I sorry, but I am going to give you the same answer as your GP. I dunno what's going on; you just have to wait a couple of weeks (to a month or so) to see if this present combo will work properly for you.

I hope that this is of some help to you. - Cam

P.S. No need to butter me up ; this is just my job.

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