Brief Answer:
Suggest- negative symptoms left after psychosis

Detailed Answer:
Hello,
The initial presentation of the patient is suggestive of psychosis- by symptoms of bizarreness, talkativeness, insomnia, etc. He most possibly never had depression as a major complaint. Even now he dosent express sadness/ low mood/ crying, as main symptoms. I think the patient is having :negative symptom in form of inability to enjoy life, which is seen many times after an episode of psychois.

Such patients after having recovered from his main symptoms of acute increase in taking, or bizarreness or may be violence or abnormal behavior- develops emotional bluntness, when they are unable to enjoy anything/feel anything.
This should be differentiated from depression - by clearly asking about their " predominant mood". If he reports it to be OK, or fine and not specifically sad/low/off, then it indicated negative symptoms which are left behind after psychosis.

Antidepressants have a minor or almost no role in such cases. The main modality of management lies in -
1. bringing back the patient to life, it's zeal, making him more communicative...all this is done by slowly, consistently pushing the patient into community by his care givers. usually, without these efforts the patient might come out very late from these symptoms or simply never make it out for himself.
2. There are certain drugs- amosulpride, which have good effect on negative symptoms of psychosis. one must try them along with the above measures.
3. making the patient help in small, significant or insignificant household chores, by praising him over his help, by talking to him ... slowly but consistently make him better.
4. sometimes, there is a part of depression involved, there one may continue with small doses of antidepressants.

Also, patient has mentioned that he feels - "life is funded". He should be asked in detail : why he feels so, what exactly this phrase means to him.
Continuing so many meds without deeply looking into his phenomenology is unlikely to help.

Lamictal is been given , But it's role here is difficult to interpret??
So, if I can get more details about this case, I might be able to help better.

Wish you good health.
Dr. Manisha Gopal
MD Neurospychiatry

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