Q. I am female, 26 years old, and have been diagnosed with depression and bpd. over the last five years I have taken many meds...and many combinations....many doses. I feel they were all given a fair length of time to work. These meds include, Prozac, Mannerex, Effexor XR, Zoloft, Lithium, Epival (depakote), Neurontin, Xanax, Ativan, and Clonazepam. Is it possible that there is no medication that will ever help me? Is it worth continuing to try new medications? I got frustrated with paying for pills that didn't seem to have any effect so I am now not taking any medication for mental illness. I find that I cycle into and out of "moods" no matter what medication I am on at the time. I can be hyper or extremely depressed to suicidal no matter if I am taking meds or not. I don't understand. Any suggestions at all?? ALSO....I have been reading about Zyprexa and its use in treating BPD....could you please tell me more about this?

A. It is important that you have taken enough of whatever medication you were on. If it works, it usually can have notable effects within 1-2 weeks. 60 of Prozac is not even close to as good as 80 mg, so dose is important. We have covered this in other letters, which you can view on the archives of this website.

Zyprexa has some promising results in its initial trials, and is as good a place as any to start. You may want to try using Serzone as 500 mg at bedtime, as it has a similar mechanism of action called 5-HT2 antagonism. The Serzone is cheaper, has fewer side effects, and will not cause weight gain.