Curbside consult


I will be evaluating a 22 year-old female is diagnosed with Bipolar II and presented as a rapid cycler. She also appears to have borderline traits. Her current medication list: Lamotrigine 300 mg at night; Mirapex (pramipexole) 4mg twice daily and Prozac (fluoxetine) 80mg daily.

The current treating psychiatrist writes: “Although she is Bipolar because she does not have AVH or SI, I will keep the current regime.”

Three weeks before he saw her there was strong suicidal ideation that resulted in hospitalization. She describes herself as hypersexual, impulsive, racing. He relationships are dysfunctional.

Is my sense of surprise much to do about nothing or might we have someone who needs to be off Prozac and Mirapex? What are your thoughts on Mirapex in Bipolar Depression? She also describes her depression as periods of anger and irritability. Makes me wonder if Geodon (ziprasidone) or Latuda (lurasidone) might be a wiser choice.

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