Here is his response:

Joseph F Goldberg, MD responded:

Dear Sarah,
Sorry to hear of your ongoing difficulties. Again, I am cautious to "second guess" the treatment of someone I myself haven't evaluated or am treating....but, that said....just about every practice guideline written in the last 15 years strongly advises the elimination of antidepressants when even low-grade symptoms of mania are present, much less escalating mania symptoms. Stimulants also really have no role when agitation is present but, like Zoloft, can worsen existing mania symptoms. I think it would be reasonable to ask your doctor what his assessment of your DSM-IV mania symptoms is, and if there are at least 2 symptoms from the list of 7 that are present, let him know your concern that the continuation of any antidepressant dose with any stimulant is known to aggravate mania symptoms; and ask about his objection to initiating a standard antimanic drug (lithium, Depakote, Tegretol, any atypical antipsychotic) as the core treatment.
Hospitalization decisions require face-to-face assessments and depend on many factors beyond just risk of self-harm, including, what the outpatient treatment is. Generally speaking, for serious symptoms that don't necessarily require an inpatient level of care, practice guidelines tend to advocate some higher level and frequency of care than visits 2 months apart. Partial hospital programs or intensive outpatient programs, depending on what part of the country you're in, typically are set up to provide closer monitoring (several days per week) and structure to assure a proper level of care. If you aren't satisfied with the level of care and standard of care you're receiving then, again, it's entirely reasonable to seek a second opinion.
Good luck!
Dr. G.