<qa>  What is the Hamilton Depression Rating Scale?Methods We plan to study two eighteen-subject groups 36 subjects total of male and female study participants between ages 18 and 65 over a 1 12 year period. The subjects will be enrolled from the inpatient units at the Beth Israel Medical Center and at the St. Lukes-Roosevelt Hospital Center Continuum Health Partners and will be followed at the Center for Treatment of the Affective Disorders in the Department of Psychiatry at BIMC. An independent evaluator Paul Teusink, M.D. not affiliated with the study will determine capacity of consent. We will select patients who would have had at least one prior manic episode and who meet inclusion and exclusion criteria for depressed acute mania Dilsaver et al, 1999. The study criteria for an acute episode of irritable depressed mania will be a Young Mania Rating Scale YMRS score of at least 11 and the Hamilton Depression Rating Scale HDRS score of at least 18 with 72 hours prior to entering the study. Patient could be randomized on study medication if shehe came to clinic on lamotrigine or Sodium valprole, but shehe has low blood level of this drug. 