Q. I am a 43 yr old female with bipolar disorder. I was diagnosed at 22 yrs. old and after some initial changes to medications, have been taking 900mg of lithium for 21 years. Lately, I have felt quite depressed, and the general practitioners who have seen me, believe that environmental stresses are the major reason for my mood. In the last year there has been a death, a move and a job loss. Actually, I plan to move back to our small town next year, as I find life in a large city a little hectic. I am also a parent to a 3.5 year old son. Since his birth and a major depressive episode then, I seem to be less resilient and more fatigued. Maybe this just goes with the territory. However, members of my online BP support group suggest I should re-evaluate my medication. I would appreciate any comments you may have. Oh yes, I have not been hospitalized for this disorder since 1982 and I don't drink, smoke or take drugs.

  A. My favorite is still Effexor XR (usually 450 mg daily) if you are obsessive, and Serzone (usually 500 mg at bedtime) if not. Both can be combined with the lithium without risk.