How do you approach a patient who exhibits classic bipolar symptomatology (including cycling sleep changes, behavioral changes, and mood changes) but has never responded to any form of adequate trials of mood stabilizer treatment?

I would question the diagnosis and look to better understand underlying anxiety, PTSD, or borderline personality disorder. I tend to see this in patient who have substantial trauma history. I look to treat the comorbid symptoms (insomnia, substance abuse, treating ADHD with an alpha 2 agonist, treat...