Question: Hello there: I am wondering if htere are drug interactions between lamictal and zyprexa? My son has been diagnosed with bipolar 1 and the psychiatrist wants to add lamictal to his treatment. What will lamictal help with in the case of bipolar disorder? My son presently works in commercial plumbing and needs to be alert to drive himself and sometimes co-workers to work, (45 minute drive) as well as to pay attention on the job, which is a 9 hour day.. It seems that this doctor has been rather quick to jump to conclusions and to want to change and increase the treatment for my son, even though he is relatively stable at the moment. She wants to meet with me as well, though, so I will fill her in. How much say should a patient have in advocating for themselves? My son has a history of over-reacting to meds such as Abilify, which has left him feeling suicidal and like a walking Zombie.The side-effects of the meds are just as disturbing as the condition being treated. Thank you for your insights! Right now, he is taking a low dose of Zyprexa 2.5 mg, at 9:00 PM in the evening, and is able to get up at 5:30 Am to make lunch and get ready for work, leaving the house at 6:00 AM. He is functioning well, so I do not know why the doctor would want to put him at risk of losing his job, due to potential fatigue and lethargy related to taking a higher dose of zyprexa (7.5 mg). He is also taking omega 3 fatty acids, D-5000, B12 3000mcg, a probiotic. Maybe she will see the situation differently, once i go in to update her. I am glad she does want to see me though, by myself. It is difficult for the patient to keep track of all that has transpired over 7 years since the diagnosis, with the ups and downs of mood swings, hospitalizations, reducing off of high doses of meds etc. Thanks you so much for your insights in relating to this doctor. The reason we asked for a referral to a psychiatrist was to for our son to have some psychotherapy, which this doctor does, and to have a community contact if his mood does start to escalate or become depressed at various times of the year. We would like to be able to encourage our son to have a voice, and not just blindly take advice and meds which could be detrimental to him, based upon his history.

Hello Dr. Sheppe: Thank you for your helpful answer!

You are right that I am having trouble trusting the medication regimes. This may be because XXXXXXX has struggled with compliance due to side effects of zyprexa, such as lethargy and weight gain. He has never used Lamictal, so I am glad to hear that this is the most tolerated mood stabilizer.

Does Lamictal result in weight gain as well as zyprexa? XXXXXXX has lost 60 pounds since being on the 2.5 mg of zyprexa, as opposed to the being on 5 mg, 7.5 mg,or 10 mg doses. Of course this is a positive for his health and his self-confidence. The psychiatrist said he could take another med to limit weight gain, the name of which I cannot remember. I do understand that the 2.5mg dose is low, but it has helped when XXXXXXX has been consistent, more accurately, religious in taking it.

It seems that XXXXXXX is overly sensitive to side-effects of medications, which then leads to non-compliance. It is a balancing act for sure. His consistent work schedule right now is therapeutic in itself, and learning to say no to too many outside demands at once is huge. I am concerned that increasing the zyprexa will lead to significant fatigue and an inability for XXXXXXX to keep working as he has been. He could become too lethargic to rise at 5:30 AM, and not alert enough to be able to drive that early in the morning. Does Lamictal typically have fatigue and lethargy as a side effect as well?

I did not mention that XXXXXXX is also taking a 2 capsule dose of Empower Plus, (see www.truehope.com for more info), a micronutrient supplement which has assisted many patients with controlling mood swings, as long as it is taken consistently and as directed. Consistency is a huge factor in whatever the treatment. I think the combination of the low dose of zyprexa and the Empower Plus, as well as the regular healthful daily work schedule, is holding Justin's mood right now. The physical work in commercial plumbing is a positive expenditure of his energy. XXXXXXX has found a balance between his daily physical work, and his filming and editing of music videos for a friend in the evenings, as an outlet for his creative side. He is tired by 9:00 PM, takes his meds and is asleep usually by 9:30 ish. On weekends he is needing extra rest to make up for the long 9 hour work days (11 hours including commute time there and back) during the week. I think he is doing amazing right now, but he has been at this job only one month. I know that bipolar is a condition that requires constant vigilance. It so often feels like XXXXXXX and his family are walking a tight-rope.

As family members we do stay connected and watch him closely, and encourage him to stay consistent with whatever treatment he is taking at the time.

How common is it that increasing a medication such as zyprexa interferes with an individual's ability to be alert for work and driving? XXXXXXX is up at 5:30 am and needs to be driving by 6:00 AM, for a full hour before arriving at the job site at 7:00 AM. He cannot take chances with being fatigued and lethargic. He also is operating some power tools at his work.

Thank you again for your insights!