The Lack of Sleep Is Throwing Him Deeper Into Depression....
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Q:  The Lack of Sleep Is Throwing Him Deeper Into Depression....

I am writing on behalf of my husband Shane.  He was diagnosed with Bipolar II in Jan. of 2011.  It was told to him that it was an underlying condition that was set off by a steroid he was given for a sinus infection.  His psychiatrist started him on Depakote.  He began at 1,000mg before bedtime and is now taking 500mg in the evening and another 750mg at night.  Shane began to feel better and then he made a mistake and stayed up 20 hours as we drove home from vacation.  Since then it seems we can't get back on track.  After an appointment about 2 weeks ago, he began taking 25mg of lamictal to help with the depression.  At first it seemed to go well, however about 5 days ago, which is about 10 days into taking this drug, he started to wake up in the middle of the night and not be able to go back to sleep.

He is calm and falls asleep easily, but wakes up anywhere between 1:30-4:00 am.  When discussing it with his doctor this week, his doctor keeps saying that it is just Shane catastophizing.  At this time, I do not believe that he is.  When he did that in the beginning, he couldn't fall asleep at all.  We are unsatisfied with this answer because we have read that lamictal can be activating and interrupt sleep.  It seems logical that the sleep problems are linked to the lamictal.  If so, will this side effect go away over time?  Is it that the depakote needs to be increased?  I realize you are not his personal doctor, but we are at our witts end.  We are looking into a second opinion, but that will take time.  Have you seen or heard of this occurring before?  My husband really does not want to be on seroquel, therefore we are hoping if we get the combination of mood stabilizers correct that that will be sufficient.

The lack of sleep is throwing him deeper into depression, hopelessness, and thoughts of suicide and with his doctor blaming him for what is happening, it only makes it worse.  It is scary because his doctor is said to be world renowned.

Please help and thank you for your time.
jennifer & Shane



I would agree with you that it initially appears that the insomnia and Lamictal do seem linked, but I also wonder about the staying up for 20 hours while driving home.  Was he hypomanic then and is now in a depressive state?  Has he had previous sleep problems when depressed?  Sometimes it can be difficult to tell if symptoms are being caused by the illness, medications or both. The lamictal can be activating but the insomnia should improve, and hopefully so will his depressive symptoms. You may want to discuss a short term sleep aid such as Ambien or Klonopin as well.  I wouldn't advise taking him off the lamictal without first talking to his doctor. If there is no improvement in his insomnia in the next couple of days, I would contact his doctor again about stopping it or changing to something like Lithium if your husband doesn't like the idea of Seroquel. 

Dr Plyler

Published August, 2011


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