May 01, 2011
Just a general note to all, when putting questions to the forum , please address it to the general forum as many other people may have suggestions about the case as well and several thoughts may be better than just mine.
back to the case
It is obviously difficult to really provide suggestions without having seen his presentation but some thoughts are as follows.
1. Lamotrigine can be prescribed as an exemption but depends upon service agreements with the phramacy , discuss this with your director as if you feel this is an appropriate indication then it may be worth it
2. it would be important to clarify if the anxiety is primary or secondary and its onset as significant anxiety can develop secondary to cognitive deficits which also contribute to the depression itself.
Therefore, treatment of primary depressive episodes as part of bipolar disorder would be priority followed by another assessment for presence of additional anxiety diorders.
A cogitive assessment is important in this case
Hopefully others can contribute their thoughts