Hello all - The website www.clinicaltrials.gov is a clearinghouse of information on treatment research studies around the country for mood disorders. If you've found traditional treatments not sufficiently helpful, consider looking into research protocols. You can search by geographic region and disorder and may find something close by that would be worth looking into.
Rather than think of a medicine like Depakote as a medicine to adjust day-to-day or week-to-week, ask your doctor what your blood level is. If you are having signs of mood elevation, increased energy, not sleeping, talking/thinking fast, etc., and a 10-14 hour valproic acid level is subtherapeutic (ie, <50 mcg/dl...and, preferably, at least 70-80 mcg/dl), then it should be raised sufficiently to reach a therapeutic level. The rule of thumb is that a dose that produces a therapeutic level is roughly your weight in pounds with a zero after it (so, if you weigh 150 pounds...1500 mg/day). If the medicine is already in the therapeutic range and symptoms persist, then it's probably wiser to add a 2nd medicine to the 1st. In true rapid cycling (i.e., 4 or more episodes per year, with an episode lasting at least several days for mania and 2 weeks for depression....separated by recoveries), the odds of Depakote alone working are only about 10-15%. With a 2nd mood stabilizer like lithium, about double that.
A number of people have expressed interest in the research behind the antidepressant efficacy of Provigil for bipolar depression. I've attached the link to the original research paper by Dr. Mark Frye on this. When used with an antimanic drug, 44% of depressed bipolar patients responded...which ain't bad.
Be aware that most insurance companies after July 1st are switching over their willingness to pay for Provigil to its new-and-improved (or at least new-and-cheaper) offshoot, Nuvigil. Also be aware that these medicines are only approved by the FDA for narcolepsy or for shift-work sleep disorder, so, even though there is research to support its value as an antidepressant for bipolar depression, that is a so-called "off label" use which means that insurance companies can decline to pay for it. Provigil is about $13-$14/pill and Nuvigil is about $8/pill. The manufacturer offers a one-time 7-day free coupon that can be downloaded at www.provigil.com which, if combined with a doctor's prescription for 7 days of Provigil or Nuvigil, at least offers a free way to find out if it may help work for bipolar depression.
There have been a number of posts regarding cognitive problems in bipolar disorder. May I humbly share as a resource the link (posted) for a book of mine entitled "Cognitive Dysfunction in Bipolar Disorder." Though it's written for clinicians, I think it's pretty accessible and may help answer some questions about the types of cognitive problems that are inherently part of bipolar disorder (especially bipolar I disorder), and the effects of medicines, both good and bad.
Lots of reasons why bipolar disorder may go undiagnosed when it is present. If only hypomanias occur, patients and doctors alike may not attach clinical importance to them or think of them as simply the resolution of depression. People also seldom "complain" about hypomanias (nobody has ever come to me to ask for help because they feel very productive and charismatic and successful). People with bipolar I disorder often lack insight about the presence of high periods and may conceal them. Doctors sometimes neglect to ask about high periods (or other comprehensive psychiatric symptoms that might go undetected, like psychosis, or substance abuse). Mania is much much easier and obvious to diagnose than hypomania. As it is said, manics get hospitalized and hypomanics gets job promotions.
Be direct. Tell your doctor about the depression symptoms you may still be experiencing. Zoloft can be effective for some people, but if you are still having depression or anxiety symptoms, then by definition the current treatment is not fully effective. Take a Beck Depression Inventory (http://www.orlandocvi.com/documents/BeckDepressionInventory1.pdf ) and rate it, then bring it to your appointment. Ask the doctor about FDA-approved treatments for bipolar depression (like Seroquel or Symbyax), or medicines that have been shown in research studies to work better than a sugar pill (e.g., Lamictal, lithium).