What should I opt for bipolar depression, Lamotrigine or ketamine infusion therapy?

Question

Hello doctor,

My wife was previously diagnosed with bipolar II and was taking 100 mg Lamotrigine daily for depression maintenance. She was on that dosage for nine years. She recently suffered a more chronic depressive episode and went out of town for ketamine infusion therapy. The infusions were very successful, and the psychiatrist who was assessing her for the infusions suggested that she did not need the Lamotrigine, that it was ineffective for treating depression in bipolar II. She tapered off the Lamotrigine, which was very difficult.

It has been three to four weeks since her last dose of Lamotrigine, and nine weeks since her infusions. She is feeling very moody and depressed, irritability, fatigue, loss of focus. The question is, do you think she needs to go back on the Lamotrigine? Or does she need to get a booster shot of Ketamine? Both are difficult solutions. Getting off the Lamotrigine was awful, and getting Ketamine requires out of town travel, etc.

Kindly advice.

Answer 1

Hello,

Welcome to icliniq.com.

I can understand your problem. Ketamine infusion therapy has great roles in depression but regular maintenance treatment is needed, which results in a significant burden on patients. Lamotrigine is the right drug for resistant depression. Even in maintenance treatment, the drug has good roles. So, in my opinion, the drug should be started again from a low dose, and gradually the doses should be built up. Lamotrigine is safe and is free of severe side effects.

I hope this helps.