Oh, and how could I forget added to the aforementioned combination of Seroquel and mood stabilizer, almost always an antidepressant. Wellbutrin is drug of choice because it doesn't alter seratonin, which is likely to induce mania, it balances dopamine and norepinephrine which are thought to be the chemical culprits along with perhaps the neurotransmitters. I just found recently that it did get approval from the FDA for the treatment of BP depression. But even many pdocs continue to write SSRIs. Go figure.
Also loved by pdocs is Lamictal, because since it is a mood stabilizer (anticonvulsant) which you more than likely already know, not only slightly stabilizes mania, it stabilizes depression. It can keep BPs from getting too low. Not usually used as a mood stabilizer by itself, in fact very rarely it can induce mania. But use with caution due to the extremely rare risk of Steven-Johnson syndrome. Titration is very slow and in small increments, about 25mg; therapeutic dose is 200mg. Any more than that seems to make no difference in symptoms.
I don't recall if I already told you all this, I apologize if you already knew, I feel rather strange trying to "educate" an MD, lol.
Its just very sad that BPs don't do well in general on monotherapy, as it is so complex and has so many features that change constantly. The perfect cocktail usually isn't so perfect after a while. Sad, but true.
So there it is, the cold hard truth. That's why (definitely no offense to you at all) I always tell BPs they should be seeing a pdoc, and I will admit, there are many bad one out there. I commend you for caring enough to research and actually ask the bipolar people themselves about it, so you can treat it safely and effectively, that is truly amazing. The ones I have worked with have all been very cutting edge, educated constantly on the very latest treatments and definitely the no no drugs that are NOT indicated. There does seem to be a high burnout factor, due to the nature of it, though. No physical tests to measure the progress of, just a subjective opinion.
Thanks again for asking, have a great day!
Variety is the spice of life, BP is the key