Q. For an unknown reason (perhaps stress from a neighbor? - I don't know. I don't do stress well.) I am cycling into a depression. My husband says I now have severe depression as I normally have chronic low level depression. Haven't been able to do ADLs (Activities of Daily Living) for several years. I can work on the computer for hours on end but have had to rely on my husband for the ADLs. This is depression as it is not my personality.

Am embarrassed about my lack of ability to perform ADLs but my husband reminded of the importance of being accurate in my description of my level of depression..

I have the BPD and Bipolar I or mixed, & GAD.
I take: Seroquel 150 mg qHS
Wellbutrin 150 mgs BID (I tried 150 TID but went extremely manic - the bad irritable, yelling kind)
Topamax 50 mg BID (more than that makes me really sick)
Klonopin 1 mg. qHS
Imipramine 25 mgs. qHS (this was added by a psychiatrist and seemed to make a difference with my past severe depression) In the past I have had good luck with Imipramine alone. However trying to take it alone recently I get hypo manic within 24 hours.
Synthroid .175 qAM

Not long ago I took myself down to 100 mgs of Seroquel for 3 days and worked 36 hours straight on the computer and only ate one fast meal during this time. When I quit I was on the verge of a major manic episode but was able to sleep.

Diagnosis of Bipolar is only a year old.

Do you recommend Serzone? How much? (By the way my cognitive skills are super affected by the meds, but it is a good trade off so I don't complain).

  A. Serzone is an interesting medication for a number of reasons. First, there really is nothing quite like it. It is a fairly pure 5-HT2 antagonist. This makes it like a half Seroquel or Risperdal. The atypicals work by dopamine antagonism (this makes you tired, gain weight, and lactate) and serotonin 2 antagonism (decreases anxiety, decreases depression, helps with somatic complaints). I believe it is a great choice in bipolars since it is more like an atypical antipsychotic than a classical antidepressant. Since atypical antipsychotics are used to treat mania, Serzone really makes sense. Second, if helps a lot with sleep. Take it all at bedtime. I usually have folks start as 100 mg at bedtime and increase it by 100 mg at bedtime every 3 to 5 days until they get up to 500 mg at bedtime, The vast majority of patients respond at this level, albeit some need more. Third, there are negligible drug interactions, side effects, and low cost with this medication. It has a very low poop out rate and no long or short term weight gain. Finally, it does not work as well if you have OCD, but it can still help.

I also have been using more and more Provigil in my patients. It makes you alert without being high. Data still needs to be garnered in controlled trials, but the medication looks great to date as an add on for energy or lethargy or depression. Provigil is very expensive, but can usually work as a single 200 mg morning dose. It mixes with virtually all medications without side effects or interactions.