Q:  Bipolar II & Lamictal : Dx'ing BP by Primary Care Doctor?

My husband was just diagnosed with bipolar disorder type 2 by our family physician.  The Dr. gave him survey because he has chronic insomnia.  He gave him a trial of Lamictal. My first question is, is it necessary for my husband to see a psychiatrist or other mental health professional?  My second question is, does lamictal help for type 2?  I only saw that it was indicated for type 1 on it's web site.

Dear Ms. M.-

Can a primary care doctor diagnosed bipolar disorder? Well, I spend a lot of time trying to teach them how to do this, so I hope the answer to that one is yes. It sounds like he used a screening form called the MDQ, which is one that I have advocated for this use. It does not give a diagnosis however, as explained on my page about the diagnosis of bipolar II on my website (you can get there from here). The trick is to combine the MDQ results with the rest of an evaluation of other markers of bipolar disorder.

Presuming for the moment that the diagnosis is correct, lamotrigine (Lamictal) is definitely a medication we would routinely consider for bipolar II. Unfortunately, it has never been studied directly in that condition, only in bipolar I, at least from the point of view of the FDA, and that is why you saw the "indication" on that website.

Dr. Phelps



Published April, 2007