Dr. Phelps:  My sister cycles every few days.  In her up cycle, she is awake but has little short term memory and trouble reading because she's forgotten words, she does not tolerate much, has no friends visiting or to talk with and is generally in a high anxiety mood.  The mood stabilizing drugs that she's been taking for 2 months have helped her to sleep better but she still cycles every few days into a sleep for several days.  For a long time she was treated for PTSD with anti-depressants which did not help.  We, her family, are at a loss as to what to do for her.

Please answer this plea because she has been cycling like this for almost 4 years.

Dear Judy -- 
Without seeing your sister, I'd best not make too specific suggestions.  However, in general it has seemed to me that avoiding antidepressants (including Risperidone, which has some properties like that) and stimulants (including excessive caffeine); and relying on mood stabilizers, though sometimes it takes 2 or three of them (including strong consideration of the new ideas about thyroid as a mood stabilizer); has helped most of my patients stop cycling.  Sometimes they come out of the cycling on the depressed side, in which case I look strongly at lamotrigine and thyroid hormone; but sometimes it seems that such folks are just going to take a few months to gradually have their mood approach the "middle" again.  The point there is to avoid giving some "antidepressant" to address the low mood once cycling seems to be decreasing or stopping, lest one start the whole thing up again.  

Remember, these are just my views.  There is no consensus at all about how to approach this.  I was encouraged to see the head of the Harvard Bipolar Research program say exactly the same thing, recently, though.  Good luck in trying to help your sister. 

Dr. Phelps
 

Published August, 2001