Q:  Rapid Cycling & Meds

Dr. Phelps,
I have been diagnosed with Bipolar II.  I've read a great deal about the subject and I agree that I am Bipolar II.   However, I often rapid-cycle.   It can go from week to week, day to day, or when it's very bad I can cycle throughout the day.   I have tried Zolof, Paxil, Welbutrin, Depakote.  None worked.  I am on Neurotin and Effexor XR now.  The Effexor XR I have been taking for two years and the Neurotin for about a month.   Neither work.  

I found a new psychiatrist (old one would not listen to me when I said Effexor was not working).  And he put me back on Welbutrin.  I am to take 150mg of Welbutirn per day and increase it to 300mg after 10 days.   What do you think?  

I am just at a loss.  I'm 25 years old and have been battling this for years now.  It impairs my functioning.  I'm a bit more stable now (able to go to school), but I cannot take on more than on task at a time (i.e. can go to school but not work or vice versa) and even that is incredibily difficult and I know I'm not performing my best due to my illness (it really gets in the way).  

Oh, I'm also an alcoholic and addict, so some meds I cannot take for addiction reasons.  Also, I was in therapy but my insurance benefits are up for the year and I can't pay for the sessions.

Any help or advice you have for me would be VERY appreciated.

Yours Truly,
Ms. S'


Dear Ms. S' -- 
You new psychiatrist might be working his way around to combining mood stabilizers with Wellbutrin.  Or some other strategy that I can't see based on this information.  In the long run I'd just emphasize to you that bipolar II is treated with mood stabilizers as the core medications, and antidepressants only with great caution in people who rapid cycle.  So, the good news is that you have only really just begun to perhaps be getting the medications regarded as routine for bipolar II (mood stabilizers).  If you haven't seen it yet, here's what I provide as basic information on the treatment of bipolar II, with references to the many mood experts who have recommended these approaches. 

Dr. Phelps