Q. I was diagnosed with BP2 & OCD in February 98. I take 300mg Fluvoxamine Maleate and 750mg Lithium Carbonate daily. In the summer of 98 I started having neurological problems, and spent a few days in hospital being checked out. It was thought that I had Multiple Sclerosis, but all the tests turned out to be clear. In the autumn of 99 I had another bad session of neurological problems, and am waiting for an appointment to see another neurologist, as I have moved house in the meantime. I also have joint damage due to having Juvenile Rheumatoid Arthritis from my late teens to early twenties, and a few other minor ailments. I have two questions.

1. Could there be any link between the BP2 and the neurological problems?

2. How can I cope with the fact that hypomania seems to occur in relation to my menstrual cycle, and 'my mind seems to wear my body out' as I overdo things, then feeling washed out and ill, as well as depressed for the rest of the time? I suffer with overspending, hypersexuality - which fortunately I manage to confine to the internet rather than real life, insomnia, very poor appetite, racing thoughts etc.. when I am 'hypo'. I get myself so worn out that when I am depressed I am totally exhausted by what has preceded it, and my general health takes a bashing. Thanks so much for your help. I'm at the end of my tether.

  A. I could hypothesize a number of ailments linked to BP2 that could look like neurological problems. Limited panic symptoms, fibromyalgia, etc., could give some of these symptoms. It is probably wise to have it worked up by a neurologist just to be certain.

If the hypomania occurs at late luteal phase, this would correspond to when your levels of serotonin are also reduced as part of the normal changes a female goes through at PMS. You may want to try increasing your fluvoxamine to 400 mg/day, but talk to your doctor first. Particularly if you are a smoker, you will break the fluvoxamine down more quickly. If this fails, try using venlafaxine at 450 mg/day or so. The extended release, if available in the UK, is preferable to the immediate release. There is a chance that you may have a rough time premenstrually until better pharmacotherapeutic agents are available. Nonetheless, it sounds like you could benefit from more aggressive pharmacotherapy.