At this time, the affected role was taking carbamazepine and valproate. Because of persistent mental condition and lability, I raised the dose of carbamazepine from 400 mg to 600 mg daily, and tapered the 1000 mg daily dose of valproate because it had been ineffective at a therapeutic dose for 1 year.
After 3 months of receiving carbamazepine at therapeutic levels, the patient's mood lability slowly diminished. Because of persistent dysphoria, angry outbursts, and diminished psychological feature, she was prescribed citalopram, and the her mood further improved and stabilized.
When euthymic, however, she continued to complain of living thing inattentive, impulsive, highly distracted, disorganized, forgetful, and fidgety, and of interrupting conversations and losing things. These persistent symptoms were confirmed by her inspiration, who attended each academic session for corroboration. Because the participant role had now been clean from essence and drink misuse, extended-release mixed amphetamine salts were added to the carbamazepine and citalopram and titrated to 20 mg daily.