Sir/ madam I have dysthymia, anxiety disorder, moderate mania, l5-s1, slipped disc, urge incontinence (overactive bladder) chronic fatigue syndrome. Last 18 years I tired so many medicines 3 months due to I discontinued medicines. I am severe lazy and very severe procrastinate. Last 6 months back psychiatrist gave me tab duloxetine20 mg, tab olanzapine 5 mg, divalproex sodium500. For 20 days. I take these medicines now. Due to corona situation I don't want to consult a psychiatrist. How continue and increase dosages. I am a pharmacist. Age 40 years. Can I take Lamictal instead of divalproex sodium. Quetiapine or olanzapine which is the beat for me.

Dr. Saranya DevanathanPsychiatrist52yrs exp

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Dear shekar, you can not stop divalproex - it is a long term mood stabilizer to prevent future episodes of either mania or depression. Now you are in depression, each relapse is more difficult to treat. Duloxetine is a better antidepressant for you since you have overactive bladder. But the dose has to be adjusted. Please do telemedicine with your psychiatrist. You may not need olanzapine at this depressive phase. Lamictal is a better mood stabilizer if your episodes are more depression rather than mania. But it can not be done right now due to covid situation. Anyway it is for a future episode. It has to be started at a low dose of 12.5/25 mg and go slowly increasing to a level of 200 mg/day to prevent life threatening skin reaction. It can not be given with divalproex. Quetiapine or olanzapine - depends on dose, your weight, waist circumference, lipid and renal profile, fastness of action during mania, sedation, affordability, etc. Please consult your psychiatrist before stopping and while starting or increasing the tablets. You can not treat yourself, even if you are a pharmacist or doctor or even a psychiatrist.  

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