Have not read all replies, so sorry if I say somethng you have already heard/thought of.
Bipolar and mood disorders toher than straight up unipolar depression should NEVERNEVERNEVER be treated with ssri's only or first. In someone with a mood disorder, ssri's may SEEM to work but they trigger mania. I have yet to hear anyone in our large bipolar depression support group say that they had ANY positive results from ssri/snri medications alone. MANY, the majority of those iwth mood disorder not otherwise specified or bipolar, have ended up in the psychiatric hospital or getting arrested for things they have done while manic on ssri/snri medications alone.
The first medications should be 1 or 2 mood stabilizers and an AAP. It can take quite some time to get the right combo, but those I kno who have found it are astounded. they think and feel like 'regular' people.
MOST of those I know, pediatrician and adults, with this diagnosis have had more than a few psychiatrists want them to take ssri/snri medications only. They don't seem to care that the rx protocol is to do the 1 or 2 mood stabs and AAP's first, then if symptoms still seem to be a problem, to add a very very low dose of ssri/snri and watch super carefully. I have been asking psychiatrists for over a decade why they don't follow the approved protocol set by the board who certifies psychiatrists, and none have given a coherent answer other than the mood stabs and AAP's require blood tests and they don't want to 'mess' with those. in my opinion it is malpractice to rx ssri/snri medications to someone with bipolar/mood disorder not otherwise specified, but it seems to be the most common first step for those who don't know to protest.
