You have a lot going on here so I am going to try to address your situations in the order you have listed them.
1) lithium was the first effective treatment for bipolar disorder and is a mood stabilizer. Lamictal on the other hand is the first FDA approved drug with the on label use for treatment of bipolar disorder as a mood stabilizer. Since the rash was identified as being related to the lithium, will you pdoc restart the lamictal? You have to be 1000% certain though that the rash was not related to the lamictal. If it was and you take lamictal again, it could be lethal.
2) There are several mood stabilizers on the market. Be patient. It might take a combination of them to get you back to the point where you feel stable. Tegretol and Lamictal work well as a combination for me but it took seven years to find this out.
3) I notice that you are not on any anti-depressants, some of these can have a stabilizing effect as well. You might want to ask your pdoc about those.
4) As you are describing it, you are rapid cycling. I hate to break the news to you but ECT while very effective in long-term drug resistant severe depression, it will not do anything for your mood swings. Bottom line is that you have to figure out with your pdoc some method of stabilizing your moods.
5) I find for myself if I utilize the principles of getting out of a rip tide, I can also better manage the mood swings that I do have. I do not hear you complaining of suicidal ideation or psychosis and thats a good thing so all we are really talking about is moderate depression to hypomania. Your life is not in danger but I hear you are suffering.
To escape a rip tide, one that drags you out to sea, if you try to swim directly to shore, you will exhaust yourself and eventually drown. The technique to escape is to swim parallel to the shoreline until you are no longer in the rip tide and then swim back to shore. How does this relate to hypomania and depression?
Rather than exhausting and frustrating myself trying to get back to "normal", I have a list of positive activities that I can utilize when I am in either state. There is a reason that we were once referred to as insane geniuses. I bet you have a creative streak in you a mile wide whether or not you have discovered it yet or not. Swim with the hypomania and use the extra umph to make your star shine bright. Conversely, I have a list of activities when I am depressed that uplift me. Going out for coffee with my daughter, watching a favorite movie, taking a bubble bath... the point is, just swim with it until you can find a solution, because it is only temporary. The mood will pass. Do whatever you need to get through it.
5) Keep up with the pdoc, the therapy and post here like crazy. You are only as alone as you want to be. Finally, don't give up. There will come a day, I promise you, where if your disease might not be a blessing, at least you can appreciate some of the gifts that come along with this malady. Hang in there, its worth it.
I will be praying for you.
ptk[/quote]

1. The process of trying to find out what med was causing the rash took roughly 3 months. in the end, the dermatologist seemed certain it was the lithium causing it, and i agreed. while we stopped the lamictal first, the rash continued. we stopped the lithium last, as i said a good 2-3 months later, and the rash was almost completely gone in about 3-4 days. i feel as though perhaps my pdoc was slightly hesitant to restart the lamictal, though. i suppose this could be my interpretation, i did not outright ask, so i admit this is a guess.

2. i feel like although the lamictal kept me afloat for the 7 years i was on it, that i would definitely be willing to add it again in combination with another mood stabilizing drug. i do feel like it helped with the depression side of things. since i posted this, i have spoke with my pdoc on the phone and we have doubled the depakote. i am cycling less, but nonetheless still cycling. only a few very intense, brief episodes that left me exhausted. not ideal, but i guess that's what i have right now. i am hoping, i guess at this point, that i just need to keep waiting. i see my pdoc in his office this week.

3. i cannot take anti-depressants. i have tried several in the past over the years, always resulting in moderate-severe (for me, at least) mania.

4. thank you for the feedback about ECT. i have mostly been curious about learning more about it, and so i appreciate your comments.

in addition, thank you for the rest of your sharing. you have good points about doing things and getting through certain times. i am in fact, what i would consider i guess a pretty creative person, that is actually what i graduated with a degree in and i use to paint on almost a daily basis. for the past 6 months i have really been struggling with these things though, so recently i have decided i am interested in maybe starting to focus my creativity in other outlets.... music, for instance.

again, thank you for your kind words.