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Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
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Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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I live in the uk and have been diagnosed with bipolar disorder.

Customer Question

I live in the uk and have been diagnosed with bipolar disorder. Today I was told I would be started on Sodium valproate and the Lamotrigine stopped. What doses get used with valproate?
Submitted: 3 years ago.
Category: Medical
Expert:  Dr. Phil, MD replied 3 years ago.

Dr. Phil, MD :

Hello. I'm Dr. Phil, licensed and practicing internist. Excellent service is my goal.

Dr. Phil, MD :

please enter chat

Dr. Phil, MD :

standing by

Dr. Phil, MD :

Hi I'm Dr. Phil

Dr. Phil, MD :

Can I ask your first name?

JACUSTOMER-grc3z72r- :

katrina

Dr. Phil, MD :

Hi Katrina

Dr. Phil, MD :

Nice to meet you

JACUSTOMER-grc3z72r- :

hi

Dr. Phil, MD :

generally the doses are 250 mg three times a day to start

Dr. Phil, MD :

and can be increased from there

JACUSTOMER-grc3z72r- :

will there be any side effects by the lamotrigine being stopped completely without it being reduced bit by bit

Dr. Phil, MD :

That is possible

Dr. Phil, MD :

I would have recommended a slower taper

Dr. Phil, MD :

It could cause some mood swings

JACUSTOMER-grc3z72r- :

what would they be

Dr. Phil, MD :

mood changes mainly

JACUSTOMER-grc3z72r- :

which way

Dr. Phil, MD :

both ways

Dr. Phil, MD :

high and low

JACUSTOMER-grc3z72r- :

I just got discharged from hospital after being sectioned for going high

Dr. Phil, MD :

okay

JACUSTOMER-grc3z72r- :

and today I was really, really low

JACUSTOMER-grc3z72r- :

so I am anxious now

Dr. Phil, MD :

I see. It seems like you might be having some withdrawal

Dr. Phil, MD :

I'm sorry

JACUSTOMER-grc3z72r- :

with you saying about the mood swings

Dr. Phil, MD :

yes

JACUSTOMER-grc3z72r- :

I haven't started the stopping of lamotrigine yet though

Dr. Phil, MD :

oh I see

Dr. Phil, MD :

you are on both?

JACUSTOMER-grc3z72r- :

I was diagnosed last year and they have been treating me with quetiapine and lamotrigine and they stopped my antidepressant

Dr. Phil, MD :

ok

JACUSTOMER-grc3z72r- :

in hospital they increased my quetiapine from 300mg to 800mg but didn't change the lamotrigine

Dr. Phil, MD :

okay

Dr. Phil, MD :

I see

JACUSTOMER-grc3z72r- :

now they are putting me on valproate

Dr. Phil, MD :

Okay.

Dr. Phil, MD :

I would ask for a slow taper of lamotrigine

Dr. Phil, MD :

and a slow introduction of valproate

Dr. Phil, MD :

I don't like switching rapidly

Dr. Phil, MD :

especially when your mood isn't stable

JACUSTOMER-grc3z72r- :

they said 250mg this afternoon at the meeting but as I was really upset I don't remember what was said exactly

JACUSTOMER-grc3z72r- :

you said that would be x3 a day

Dr. Phil, MD :

well maybe they are starting very slow

Dr. Phil, MD :

usually it is three times a day though

JACUSTOMER-grc3z72r- :

but do you think they meant that x3 a day

JACUSTOMER-grc3z72r- :

oh you just said that, sorry

Dr. Phil, MD :

no problem

JACUSTOMER-grc3z72r- :

what is the quetiapine for

Dr. Phil, MD :

also a mood stabilizer

Dr. Phil, MD :

similar to the others

JACUSTOMER-grc3z72r- :

I thought it was an anti-psychotic

Dr. Phil, MD :

it was originally marketed as one however it is used in bipolar for mood stabilisation

JACUSTOMER-grc3z72r- :

why would one psychiatrist insist it be 300mg and now many months later they have increased it to 800mg

JACUSTOMER-grc3z72r- :

another doctor did I mean

Dr. Phil, MD :

perhaps because you were still getting manic

Dr. Phil, MD :

wanted to try to lessen the mannia

Dr. Phil, MD :

mania

Dr. Phil, MD :

that is my thought

JACUSTOMER-grc3z72r- :

I told them that everything that's really good is dulled on this level of quetiapine, like the vibrant colours and the spped of the life around me etc

Dr. Phil, MD :

yes, I can understand that

Dr. Phil, MD :

It is a massive dose of quetiapine

JACUSTOMER-grc3z72r- :

the doctor said she would reduce it to 700mg

Dr. Phil, MD :

truthfully I have never seen a dose that high

JACUSTOMER-grc3z72r- :

what 700mg

Dr. Phil, MD :

yes

JACUSTOMER-grc3z72r- :

what would that mean?

Dr. Phil, MD :

nothing just a higher chance of side effects

Dr. Phil, MD :

you seem to be doing alright on it though

JACUSTOMER-grc3z72r- :

does it relate to my condition in any way that it's that high

Dr. Phil, MD :

no

Dr. Phil, MD :

it is just a high dose

Dr. Phil, MD :

perhaps you need it

JACUSTOMER-grc3z72r- :

I don't understand then

Dr. Phil, MD :

I'm not sure. I don't know the ins and outs of your case

Dr. Phil, MD :

there is really not much to understand

Dr. Phil, MD :

I was just commenting that it was a high dose

JACUSTOMER-grc3z72r- :

but you said maybe I need it but it doesn't relate to my condition, which doesn't make sense?

Dr. Phil, MD :

Oh I didn't understand what you meant.

Dr. Phil, MD :

I'm sorry

Dr. Phil, MD :

Yes, it relates in that they are giving it for bipolar

JACUSTOMER-grc3z72r- :

so what determines the dose of quetiapine given

Dr. Phil, MD :

the doctor giving it and your symptoms

JACUSTOMER-grc3z72r- :

what symptoms

Dr. Phil, MD :

the mental symtpoms

Dr. Phil, MD :

if mania persists on 300 mg they may up it to try and control it

JACUSTOMER-grc3z72r- :

if quetiapine is being used as a mood stabiliser why do they have to use another one?

Dr. Phil, MD :

Katrina, with all due respect, you are asking me to hypothesize about why your doctors are treating you a certain way

Dr. Phil, MD :

I think that is out of the scope of what I can accomplish online

Dr. Phil, MD :

I cannot safely do that

Dr. Phil, MD :

your original question was what dose of valproate gets used

Dr. Phil, MD :

I answered that and many others.

Dr. Phil, MD :

wouldn't you agree?

Dr. Phil, MD :

hello?

JACUSTOMER-grc3z72r- :

You did answer that. I didn't realise how specific the initial question had to be. I'm sorry you feel the way you do and that you seem disinterested. Thank you for your time anyway. I think the money asking to be paid is too much for what you have given though. I wish you well anyway.

Expert:  Dr. D. Love replied 3 years ago.
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