The American Psychiatric Association in its 2002 Bipolar Treatment Guideline unequivocally advises against doctors prescribing our population antidepressants without a mood stabilizer. These days, there is an impressive body of psychiatric opinion that posits that even with a mood stabilizer, antidepressants pose too great a risk.

Believe me, Stewart, had I taken one more antidepressant, my family may well have wound up taking a drug company to court. Instead, miraculously, that antidepressant delivered me.

I was manic. I was flipping out. But I wasn’t depressed. I wasn’t suicidal. A crisis unit psychiatrist put me on a mood stabilizer (with a different antidepressant) and I leveled out.

Last year, I was having a conversation with a good friend of mine about making out an advance psychiatric directive should I ever get suicidally depressed again. The context of the conversation was ECT, but then I brought up my experience. Then a lightbulb went off:

Suppose, I ventured, my psychiatrist and I were to reach this kind of understanding: If I ever got suicidally depressed (which by definition is a life-or-death situation), maybe he should take me off my mood stabilizer and prescribe me an antidepressant.

Or for that matter, a stimulant or even a recreational drug. Anything to quickly get me out of my killer depression.

But with this proviso. I must be in a locked unit under constant surveillance. Inducing a mania is definitely not the sort of thing to try at home. Then, once I’m up, we put me back on a mood stabilizer.

Let me make this clear, Stewart. This was just a conversation, but you are entitled to initiate this discussion with your psychiatrist. If your psychiatrist practices good medicine, he or she is almost certain to forcefully rule out this option. The profession does tend to take that “first, do no harm” rule pretty seriously. You may reject the idea as out of hand, yourself, but you are also entitled to keep badgering your psychiatrist.

Right now, the only treatment to get an individual quickly out of depression is ECT, which did not work for you. We need to get serious about coming up with other options. I know from personal experience the pain you are in, Stewart. Believe me, for your sake - and for the rest of us - we need to start putting ideas on the table.