Q. I have been on lithium for over 2 years now as well as having been through several different antidepressants, such as Prozac, Serzone, Zoloft, and Wellbutrin....currently I'm taking Effexor XR.

My question deals with the statements on the mhsanctuary web pages bipolar disorder...they state the patient should not be diagnosed as bipolar if the manic episode is a result of medication. I have never had a manic episode until I took Paxil, and then later, Prozac for depressive episodes, before having taken lithium. I had mild hypo-manic episodes during extremely stressful periods, but for the most part, depression has been my difficulty since my teen years though I never sought help till I was 33yrs old.

What, if not bipolar II, is my problem? I cannot take the anti-depressants without developing manic or hypo-manic symptoms, yet the medication I'm taking now is not only causing serious fatigue, (I participated in a sleep study and the results were either, narcolepsy or dropping off to sleep so quickly is medication induced), but I hear it (Lithium) is very dangerous for pregnancy/fetus. I was hoping to have a child within the next two years. In addition, I am quite overweight (+ 50lbs.) and can't get it off, which I think would be better for a healthy pregnancy as well.

I definitely do have depression episodes, not necessarily coinciding with stress or unhappy events, so giving up antidepressants doesn't appear to be an option. I've never attempted to harm myself, but ideation is a strong leader of my thoughts. I have a 7yr old son for whom I wish to remain in good mental attitude for.

  A. Regardless of what we label your illness, you definitely have an illness. There are a number of reason for the hypomania. They could be induced by antidepressants. It could be that you have too little antidepressant in you and just need higher dosages. It could be that another process is going on simultaneously, e.g., you have two diseases at the same time.

There are no easy answers. Depression is easy to treat during pregnancy, as most of the newer antidepressants are viewed as being relatively benign during pregnancy. The highs, however, are another matter. First, get well. If you cannot do this, the pregnancy will be difficult to impossible for you. Then, if all is balanced, work closely with your doctor to insure a good control of your symptoms. Finally, if all else fails, get another opinion from a specialist in the area of bipolar disorder. University teaching programs all tend to have an expert.