Q. Hello.

I have once responded well to Prozac (4 weeks, about three years go, prior to knowledge of my childhood ADD and subsequent BPD). I decided to try Prozac, but due to a lot of stress and anxiety, I got extremely anxious and on edge when I took it, almost like a bad trip... these side-effects were almost unbearable - needless to say I stopped.

I have been on Buspar (20-25mg p/d) for 2 weeks now, and the anxiety seems to have subsided noticeably, yet the depression and mood-swings/irritability are still there. This is extremely frustrating, as I am emotionally well trained enough to realize this, but am nevertheless at the mercy of my condition.

I am in psychotherapy, and feel I would benefit a whole lot more from if I was able to take an anti-depressant. I have recently moved to the UK, and my first appointment with a psychiatrist here is only in 6 weeks... yet I have these urgent questions: After how long of Buspar treatment is it advisable to start Prozac again? Should I be starting at 10mg p/d? Do I then take Buspar with Prozac? I can get access to Prozac through my GP. I have been advised to take Tegretol, but am not sure whether this is necessary in my case, as I do not experience rage or suicidal thoughts. (I did have suicidal thoughts during an extreme period of anxiety).

A. It is hard to give you good advice without doing a diagnostic interview. All of the SSRIs-Prozac, Zoloft, Paxil, Luvox, and Celexa can cause anxiety. Adding BuSpar probably will not help a lot here to reduce the anxiety you experience. If you are not obsessive-compulsive, Serzone at 500 to 600 mg at bedtime works well for many people as a solo agent. It treats the BPD as well as the anxiety. If it does not work, or you have OCD, Effexor XR is a better choice since it has been shown to decrease anxiety and BPD both.