bipolar disorder, Dr. Paul Markovitz  Q. Please help. I am living in fear. I have had a diagnosis of bipolar disorder for 18 years and remained symptom free on lithium until the past five years. Menopause caused complete chaos, with rapid cycling and mixed episodes. I have been put on Neurontin for these with good effect. However, for the past year I have had rages (and I mean rages, almost homicidal or suicidal) and the Neurontin has done nothing to cure these. They seem to occur around the 21st of each month and sometimes on other days which suggests hormones although I have not had a period for two years. I have tried everything. Nobody seems to have any suggestions, even my psychiatrist and therapist. Nothing I do for self-help works either. What more can I say? I need help before I do something violent. Do you have any suggestions that I might try?

  A. There are a few things to try. One is to add on a second antiepileptic drug to the Neurontin (Lamictal, Depakote, Topamax, Gabitril, Tegretol, or Trileptal are all possibilities). A second would be to add on a medication that decrease rage like Serzone, an SRI, or Effexor. Finally, some folks benefit from low doses of estrogen if it is cycle related. Discuss it with your psychiatrist and OB/GYN.