Hello Doctor, I am a 30 y/o male. I live in Hong Kong and back in July I took a trip to the USA to visit my family. I had been taking a combination of Effexor XR 37.5 & Lamictal 25mg with good results (about a year) for what I thought was treatment resistant depression and anxiety. The problem started the day after I returned to China. Had a busy 1st day, we did not have any food at home, so my GF wanted to go to the local supermarket to buy some snacks. We drove there and found that the supermarket was going out of business and everything was 75% off, my GF being a girl, her eyes lit up. We stayed over 5 hours I was exhausted. Went to bed at about 9pm and woke up the next morning to anxiety, it progressed throughout the day until constant panic. This went one for over a week, it was not panic attacks, panic attacks dont last for days. I felt like electricity was shooting through my body, it was horrible. I was unable to sleep, I probably slept no more than 1-2 hours a night for 1-2 weeks. I tried to go to work but was sent home, everyone could tell something was wrong, I was pale, pouring sweat and shaking all the time. Then I got slammed with the deepest darkest depression imaginable, not a normal depression a terrible black hole. Whenever I took effexor during this time it was very activating and It made me unable to set still, I had to pace or be moving and my skin burned. Here I am now, 6 months later feeling miserable, I am better but feel like my brain took a hit, I have bad depression and feel cognitively off. I am getting periods where I feel back to normal, I hoping thats a good sign. Something very similar happened in 2009, at the time I thought it was alcohol withdrawal, I recovered fully but it took about 10 months. this sound like some type of manic or mixed episode? If so, why do I feel cognitively off, do episodes damage the brain? I am seeing a Psy now (no diagnosis) but wants me to raise the lamictal to 200mg, im at 50mg now working up.