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GK is a 50-year-old woman who came to me for the first time a couple of weeksago describing a long history of depression punctuated by hypomanic episodes.Her thoughts were racing a bit, and her spending and sexual impulsivity had beenthreatening her marriage. We began a combination atypical antipsychotic/selectiveserotonin reuptake inhibitor, and within days she reported feeling "clear and atease," a mental state she had not experienced "in 4 score and 7 years."