Little Bear also is technically diagnosis with Mood Disorder-not otherwise specified also because of his age even though everyone suspects Bipolar diagnosis.
Deciding upon medications is definitly a very personal decision that every family needs to make based on what is best for them. We decided to do medications when no natural remedy worked. I went to an herbalist, did special diets, vitamins, and for us none of these worked for us. If you are having any doubts you could try some of these under your doctor's strict care of course.
After I read The Bipolar Child and weighed everything for us, the deciding factor was that I wanted Little Bear to have the best chance possible of getting this controlled early. He was getting worse as he got older and I worried about suicide, drug abuse, etc. as he grows into an teen and then an adult. All of these STILL scare me but at least I know we are doing everything we can. Again this is a very personal decision for each family to make so talk it over carefully with your doctor.
They won't do blood levels on the depakote until a month because it takes at least that long to get it into the system at a theraputic level. Depakote is a Mood Stabalizer which is a totally different drug than the Abilify which is an Antipsychotic. Since they are different classes of medications one does not replace the other one. Our Dr. also tried all of the antipsychotic's first such as risperdal, abilify, seroquel because they don't require blood draw's and the side effects are typically milder. So far Little Bear has not had any significant side effects with any medications so far.
We ended up having to combo the two together due to Little Bear's manic episodes which were gruelling and scary at times.
I hope this helps and I am sure someone else will have some great advice also