Experienced an Episode While on Lexapro, Lamictal and Geodon
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Q:  Experienced an Episode While on Lexapro, Lamictal and Geodon

Is 40 mg of Lexapro a dangerously high level of SSRI for someone who is  bipolar? I was taking this in addition to 300mg Lamictal and 10mg Geodon when I had a severe manic episode, looking for answers as to why I would have an episode while on medications. Thank you in advance.       


Dear Amy --

Establishing cause and effect in this business is tricky. Whether antidepressants really cause manic episodes is even still in some doubt in some psychiatrists' minds.  Not many, but there are a few doubters.  Some of them are smart.  Some of them appear to me to have blinders on, but I have to admit they are smart. 

For example, here is a graph from a research study that was just published.Amsterdam You see mania scores (the YMRS) plotted over a period of 12 weeks during which time people with bipolar II depression were given either venlafaxine (Effexor) or lithium.  The authors do not regard the single spike on the left as having clearly been caused by the antidepressant.


The spike starts about two weeks after the antidepressant was initiated.  Getting above 12 on that scale is enough to get you into a research study for the treatment of mania, and this patient reaches 18.  But still, the authors glossed over this one patient's experience. For him/her, just like for you, there's just no clear way to establish whether that manic episode might not have occurred regardless of medications taken at the time. It is the nature of bipolar disorder to have episodes periodically.  

Mind you, I don't think that means we can ignore events like the one in the graph above, nor your experience either. It is just that establishing causality for certain is always just out of reach in this kind of situation. So unfortunately, even with good homework, it would be difficult to establish that Lexapro was the culprit.  Sometimes low-dose Geodon seems to act more like an antidepressant as well. 

 At this point the focus should be on making sure you have a plan in place to prevent another such episode -- which, of course, is not saying much, as that is the nature of the game in bipolar disorder, trying to get mood stability and prevent both subsequent manic than depressive episodes.  Good luck with that process.

 Dr. Phelps

Published May, 2008


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