Brief Answer: Valproates, ECT, kitamine Detailed Answer: Hello, Thanks for choosing health care magic for posting your query. I have gone through your question in detail and I can understand what you are going through. I understand that you have already tried quiet a plenty of drugs but its unfortunate that you have not found the right choice of drugs. But the treatment of bipolar mood disorder has always been so. Try and experience. Some of the options which I would like.to suggest are 1. Taking valproate or divalproex as a mood stabilizer along with an antidepressabt like mirtazapine or venlafaxine. Even lithium is a good option instead of valproate as a mood stabilizer. 2. Modified ECT therapy. This is very useful especially if it is resistant case of bipolar depression and all the more indicated if the patient is haing suicidal thoughts. Very safe, very effective and very swift. In the current case it would be my treatment of choice. 3. Kitamine is being used as an injection to break a resistant depression. It is administered on alternate days and response in within 2-3 days. Its an oflabel use but very effective and recent research is supporting it a lot. There are a couple of more options as well but these are the best possible options. Hope I am able to answer your concerns. If you have any further query, I would be glad to help you. If not, you may close the discussion and if possible you may rate the answer for me, so that I get a good feedback. In future if you wish to contact me directly, you can use the below mentioned link: bit.ly/dr-srikanth-reddy Wish you good health, Kind regards Dr. Srikanth Reddy M.D.

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