Q. I am currently suffering DAILY cycles which are driving me mad. I am taking Quilonum SR 900mg a day. I have been taking now for about 3 weeks. About 6 weeks ago I started taking Epilum which was OK but I took a Dyprexa tablet for mania and had an awful experience with it. I virtually slept for 3 days and had extremely bad thoughts for days afterwards. I then went into deep depression for 6 days. From there I started taking the Quilonum SR and have been going downhill ever since and for the last 2 or so weeks the cycles have become predictable and worse. My Doctor says we should just battle on but I can't. I am exhausted. I am suffering extra bad headaches, teeth are aching, severe irritability, a dopey full head and a lot of other symptoms.

I want to know the best medicine for Quick Cycles. There doesn't seem to be much information on this problem.


  A. The treatments of choice for rapid cycling bipolar illness at this time seem to be anticonvulsants as a primary agent and the newer atypical antipsychotics as a secondary choice. The antipsychotics are rapidly moving closer to first place. The anticonvulsants with efficacy in controlled trials are sodium valproate, gabapentin, carbamazepine, and topiramate. Antipsychotics include risperidone, ziprasidone, clozapine, quetiapine, and olanzapine.

If you have borderline personality, and this is the cause of the rapid cycling, you might do best on venlafaxine, sertraline, fluoxetine, of fluvoxamine at high doses. Some folks also benefit from nefazodone if their illness is not associated with obsessive compulsive symptoms.