Q. I have been diagnosed as Bipolar II, very rapid cycler. I have tried every antidepressant there is (except the MAOI's) but all have induced rapid cycling. In other words nearly all of them work very rapidly to clear the depression, but then I go on to have another depression and they are ineffective and also induce anger and irritability. I have tried Depakote (caused severe apathy) and Lamictal (was GREAT at first but then began to cycle and it quit working). My last resort is now to be put on Lithium. My worry is that I ALWAYS have the pattern of :depression, than hypomania than a normal period than it begins again. Will Lithium EVER work when someone has this pattern? I am losing hope.

  A. Lithium has a lower efficacy in rapid cyclers than non-rapid cyclers, but still works. You clearly have a biological illness, and it requires a biological intervention. Lithium is a good place to start.

The Hopkins group (with Prozac) and Univ. of Pennsylvania group (with Zoloft) showed that high dosages of these work as unimodal agents in BPII rapid cyclers. If you were on low dosages of either, you may just need bigger amounts to work. The size of the dose is of critical importance. Do not give up hope on these agents until you have been on > 80 mg/day of Prozac or > 200 mg/day of Zoloft.