Lamictal & Risperdal Combo & Hypomania
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Q:  Lamictal & Risperdal Combo & Hypomania

Hi, Dr. Phelps

I have a question for you about Lamictal and Risperdal.  I was tentatively diagnose as bipolar after the birth of my first child six and a half years ago.  I was given Zyprexa but I gained weight so I went off of it.  I never returned to the doctor and I remained unmedicated for six years.  During that time I had depression alternating with major anger issues and high anxiety with sleep disturbances.

 I finally dragged myself to a p-doc a few months ago after I had a mixed state of major anxiety and emotional lability.  I also went without sleep for three days straight although I still managed to go to work and take care of my kids.

My new p-doc prescribed Seroquel which did nothing for my mood but it did help me sleep.  After 2 weeks she gave me Lamictal in conjunction with the Seroquel.  The Seroquel was slowly titrated to 100 mgs but I actually felt worse on the med.   One night I didn’t even sleep at all despite taking  100 mgs of Seroquel. My p-doc eventually dropped the Seroquel completely and added .5 mgs of Risperdal on top of 100 mgs of Lamictal. 

After the first day on the new combo of meds I became extremely euphoric and overly energetic.  It lasted  5 days and I slept for a total of 4 hours in that time.  I am not complaining, mind you.  I felt great!  I was very productive at work and my kids loved it. 

I eventually came down from my pleasant hypomanic state but I didn’t crash into a depression like I thought I would.  Instead I became calm and I felt very relaxed.  Have you ever heard of the combo of Lamictal and Risperdal enhancing or causing hypomania?  I am curious to know if this will happen again when the p-doc increases my dosage at our next appointment.

Thanks in advance for your help!

Dear Amber -- 
Have I heard of this combination doing this: no.  Have I seen this pattern: yes.  People can go into a hypomanic phase as they shift from a mixed state, even without medications involved.  However, risperidone is also known to cause hypomania (how often is debated
e.g. Aubry; in my experience, it is not uncommon), so it could have been the risperidone, as an initial effect somehow.  Or it could be the combination with lamotrigine (the latter supposedly does not do this, though some of us still wonder about that and there at least one case report of hypomania associated with lamotrigine).  

Will it happen again?  Fair question.  You can see from the above paragraph, here comes another disappointing answer, like, uh, can't say, could be, depends on how the first one happened and we obviously can't nail that one down.  I hope things continue to go smoothly (in which case the dose increase you were looking at might not be necessary?). 

Dr. Phelps

Published December, 2004


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