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Do I have bipolar affective disorder?

Q: I have been taking treatment for resistant rapid cycling with antidepressants and lithium. Currently I am on Lamotrigine but it is also not helping. Please tell me what to do as I am severely depressed. Which mood stabiliser should I take before starting antidepressants?

A:Bipolar affective disorder with rapid cycling responds well to anti-epileptic’s (not lithium) i.e., Divalproex, Lamotrigine, Carbamazepine. They can be given alone or in combination but should be given in the upper level of the therapeutic dosage i.e., Divalproex – 1500 – 2500 mg / day, Lamotrigine 300 – 400 mg / day, Carbomezepine 900 – 1200 mg /day. Try to avoid antidepressants (both old and new) if the depressive episodes are short lasting, as they themselves can precipitate rapid cycling. One thing you need to have patience. This is a life long illness which can be controlled by proper medication. We as a 'team' need to find that 'medication' which will help you.

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