Well... lithium has a mixed bag of studies at its back.

In general it is more of an antimanic. it tends to flatten mood altogether if too much is taken... however it has been shown in some studies to decrease the risk of suicide... even though it is not particularly successful for mixed moods (statistically) compared to divalproex.

i have not seen data of it specifically being used for an antidepressant effect however, and it is definitely used along with ADs as necessary.

Certainly Lamictal would be appropriate for that. However if one is bipolar and not stable, it is important to realize that Lamictal alone will not protect against mania, and since it is called a "mood stabilizer" in the literature even ... it is easy for one to think it covers both bases, when that is not the case.

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Bizi, I'm not sure i can offer any advice about sleep. do you take supplements? Magnesium - usually taken with calcium and vitamin D for proper balance assimilation can help with sleep. a simple way to get it is by having a glass of hot or warm (but not boiled!) milk before bed.

another thing, if you can, is to keep a check on your alcohol intake especially in the evening. whereas alcohol does make one sleepy, it gives rise to poor quality sleep, and often also reduces the amount of sleep one is able to get. hormonal changes can also affect the way alcohol affects you, btw.

i do not wish to advise one way or the other on hormonal therapy to help with perimenopausal symptoms, since such therapy could possibly interfere with your meds. but some women do find it helpful during perimenopause.

you might want to speak to both your gyn (first) and your pdoc (once you know what you could be given) about this avenue. This is a tricky juncture for bipolars. i am not there yet but not far and i don't look forward to it.

~ waves ~