You asked: my daughter is diagnosed with bipolar 2, for the past two years. For the past 6 months she is on lithium 750 mg, qutipin 300 mg and lamotrigine started with 25 mg gradually increased to 200 mg. According to the psychiatrist she is having lamotrigine induced switch now with decreased sleep, flight of ideas and restlessness. Lamotrigine has been tapered to 75 mg. Serum lithium 8. Psychiatrist told this switch is rare and we will wait for more time for improvement. Kindly advice regarding further course of action. How long it will take for her to get better.

If she is cooperative with the medication and starts therapy too, there is a good chance of her recovering. In therapy she will learn a lot of new skills, tools and techniques to help her cope with her condition. She must be on a program of exercise, proper rest/sleep, good diet, and be on a tight schedule of mind and body occupying activities. She must deal with her emotions particularly anger, which may have childhood origins. If she can be free of any episodes for three years, then she can be weaned off of the medication but always in consultation with her doctor. Because of her condition, she may feel like she is cured and may insist on coming of the medication but only the doctor should decide that. There are certain adaptations that are suitable during the manic phase and certain for the depressed phase.

Please recheck serum lithium level. If she is having lamotrigine induced switch it will take at least 8 to 12 weeks to come back to normal. The other medicine given along will help in controlling the symptoms with proper dosses. Patience is required in such cases,