Successful and steady response to a combination of lamotrigine and quetiapine of an extremely refractory bipolar I patient previously published as a case report: a seven years follow-up of the case report

Background

We report the seven-year follow up of a 40-years old female bipolar I patient previously published as an extremely refractory depressed patient who had previously responded only temporarily and only to high doses of clomipramine intra-venous (6 amp daily) plus oral 225 mg venlafaxine, in 2000.

Materials and methods

During the 6 years that followed the patient manifested her first manic episode while for the rest of the time she was continuously depressed and attempted suicide three times. She received ECT without any benefit. She presented to us again after her last attempt. The diagnosis changed to Bipolar I disorder, current episode depressive. She was put on quetiapine 1500 mg, lamotrigine 300 mg and topiramate 50 mg daily. For the next 7 months the patient was normothymic with no residual symptoms.

Results

This was the second true normothymic interval (after the 37 days that followed intra-venous clomipramine) since the onset of her disease at the age of 26.