Interesting how all six choices involve either an increase in medication (#1, #2) a substitution (#4), no change in dose (#3, #5) or a temporary decrease in dose followed b a return to current baseline (#6). No choices that involve a permanent removal or cutting back on anything.

I'm a little leery of this. Do "pdocs" just expect people who are already experiencing nasty side effects from their drugs without any measurable attendant benefits to just take more and more medications at ever-increasing doses until their bodies become such toxic waste dumps that it would be impossible to notice a full-scale nuclear war outside, much less symptoms of mania or depression?

Moose, you yourself have reported that you get more relief from listening to music than from anything else. What about exercise, e.g., some nice long walks? Without jogging I am toast. And writing, here and in the form of e-mails, seems to get you through some tough moments as well. Whatever it takes to get you through the mornings and nights, do it. I'm helped lately by my almost incessant blogging, since I'm home so much and always near a computer since what little work I am doing these days involves an Internet connection.

I am on 1500 mg a day of Depakote and it seems to help with tendencies toward (hypo)mania. I also had a pescription for trazodone (100 mg PRN), and while it definitely helps knock me out, I don't like the hangover-ish effects and doubt I wil renew it. I am fortunate in that I can get prescriptions for $4 but am actually glad I don't have health insurance because otherwise I would probably have wound up on one of the expensive, high-powered zonker drugs and lives to resent it.

Anyway, you have friends here.