Diagnosis is bipolar disorder mixed.
I begin in low doses, around 10 mg once to twice daily, and increase it if tolerated and tremors persist. Diagnosis is bipolar disorder mixed. A. ECT would not be unreasonable. I would emphasize that it is important to make sure that this individual has failed all mood stabilizers in the absence of concurrent antidepressant treatments. This is because antidepressants can cause rapid cycling and act as mood destabilizers counteracting the benefits of mood stabilizers.