Q. I am being treated for BPD by a general medical doctor since I live in a rural setting. My previous experience with SSRI's including serzone and zoloft induced what felt like mania to me. So, to prevent bipolar symptoms, he tested my lithium level and it is low (.3L). He prescribed lithium carbonate 300 mg, one per day. Two months later my lithium level had not risen, so I am to take two a day. This is in addition to Prozac. Question: Do you agree that I need to increase my lithium level to feel better, and will this counteract the Prozac? It feels like it is doing so. How does a low lithium level actually effect behavior? My web research only showed lithium as being useful when in an acute manic episode, which I am not.

I was just reading your answers about meds and you said the prescribed amount for Prozac should be no less than 80 mg. I am on 20 mg, once a day. Prozac 20 mg once a day, lithium 300 mg twice a day, synthroid .1 once a day, and Prempro .625mg/2.5mg. once a day. Is this a good or bad cocktail, in your opinion?

A. Not to sound corny, but it is a great cocktail if it works, and poor if it does not. If you have two or more of carbohydrate craving, headaches, migraines, irritable bowel, PMS, rage, obsessionality, mood swings occurring for hours, impulsivity, fibromyalgia, panic, anxiety, or depression still ongoing, it is not good.

I stand by the data if you have BPD as we have conducted and published controlled trials of Prozac, and it takes 80 mg/day in BPD. Lithium is partially effective at best (studies done by Art Rifkin in the early 1970's), and makes most people feel poorly. The PremPro is fine, and not very likely to worsen your condition or help.