Preliminary Schema for Antidepressant (AD) Use in Depression Breaking Through One or More Mood Stabilizers (MS)

I. (A). Non-rapid cycling
           Add AD

   (B). Rapid Cycling or polyphasic episode
           Add 2nd MS, especially lamotrigine
                    Add 3rd MS
                            Add AD

    (C). Adjuncts for:
           Sleep, Anxiety, Agitation:
            High potency benzodiazepines
            Gabapentin

           Memory:
            Donezepil
           Calcium channel blocker?

           Alcohol:
            Naltrexone
             Acamprosate

II.  If Non-response to MS + AD
      Lithium Augmentation
       

III.  Antidepressant Adjuncts
      Sleep Deprivation
      High Lux Light Therapy
      Omega-3 Fatty Acids
      Ascorbate
      Folate

From Bipolar Network News Volume 7 Issue 1 http://www.bipolarnetwork.org 

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