I turned out to have an allergic-like reaction to lamotrigine, so, none of that for me.
The second they tried with me, divalproex sodium (Depakote/Epival,) works like a charm, at the right dose. It acts as an antidepressant for me, which is usually my main problem.
I can apparently have breakthrough symptoms/episodes, as my recent mixed state over this past month demonstrated. But apparently this is not too unusual and commonly related to things like seasonal changes, for example. Yay for spring! I then required additional medication therapy while IP for about a week to get the hypomania end of my mixed episode under control. They used a combination of clonazepam, quetiapine, and Zopiclone, along with my regular daily dose of divalproex -- and they took me off my Concerta just for the duration.
I'm back on the Concerta again, clonazepam has been in my little collection for a while for anxiety issues, still on divalproex and now I have Zopiclone for sleep issues which can crop up for me time and again - not necessarily related to the bipolar, hell, my ADHD makes staying up allll too easy.
I also have quetiapine added into my cocktail now. It's supposed to be a PRN like my clonazepam and Zopiclone, but I've been having success with it as a daily med... not for my bipolar, really, but more for some of my OCD-related things and dermatillomania. I'll be speaking with my pdoc about her thoughts on this during our next appointment.
I am comforted by the thought that if it ever turns out that my divalproex *does* become less effective, I have lots and lots of room to go up on the dose. Both in terms of how much I take per day and in blood levels (I'm at the lowest end of 'effective blood level' for valproates, upon blood testing.)
*** oh, and it took about a year for me to have a breakthrough mixed episode after we got me on the divalproex. And after about two weeks of treatment for it I seem to be getting back to normal.