Q. I have been diagnosed with both bpd and bipolar type II. I have tried Wellbutrin, but am unable to tell if it works. I have also tried Effexor, but could not tolerate the tremor or the sweating. I was recently placed on 300 mg of Wellbutrin, 15 mg of Buspar twice a day, 100 mg of Topamax, and 20 mg of Paxil. My usually painful and unbearable depression turned to apathy and lethargy. I began sleeping 12 to 14 hours per night and still felt sleepy and physically and mentally weak. I was not, however, suicidal. I was just...there. I had stopped crying every day and felt less needy, but I also did not feel any motivation or joy even in joyful situations. A few days ago I ran out of the Buspar and at the same time I decided to stop taking the Paxil because I decided that it was the culprit causing my sleepiness. This is my second or third day without those two and I am miserable! I am back to crying. My painful, suicidal depression is back, but I am a little more awake. This morning I went to the doctor and he decided to keep me on 300 mg of Wellbutrin, 15 mg of Buspar twice a day and he added 300mg of Neurontin at night. here are my questions:
1) Was the Paxil actually helping despite the sleepiness?
2) Is being an nonfeeling zombie the price that one pays for keeping oneself alive? Must I choose between drastic ups and downs and a ridiculously steady middle ground?
3) Can I actually expect to feel normal (as if I know what that is) by taking medications or are these altered states the best that I can expect?
4) The doc also said he may add more Neurontin, add Lamictal, or add Prozac. Do any of these sound promising with or without the Wellbutrin and Buspar?

  A. The questions are all good ones.
1. The Paxil may have helped, or it may have been a combination of everything you were on. The Paxil does make many folks sleepy. The flat feeling of nothingness is called asthenia It is a side effect common to virtually all the serotonin reuptake inhibitors. Zoloft may work better since it has less chance of causing that flat feeling. There is, however, a higher chance of tremor and sweats. The tremor can be treated with propranolol sustained release (Inderal SR) and the sweating frequently gets better with Levsin SR.
2. No. Many folks feel regular ups and downs with the medication, but not the exaggerated ones you have been getting. If you are "flat" you have to decide if it is better than the alternative until something better comes along. That is a call you and your doctor need to make.
3. You can get a lot better. Normal covers a lot of ground. I am not avoiding giving you an answer, I just do not know what your definition of normal might be. Hopefully you can achieve it. Suicidality, mood swings of an inappropriate nature and degree, anger, sleep problems and somatic complaints can all be helped or resolved.
4. My original work on BPD was with Prozac (American Journal of Psychiatry, Aug 1991) so Prozac can work for many individuals. Neurontin, Lamictal, Topamax, Depakote, Tegretol, and so on may help, but they are not very good antidepressants overall. They are better at stabilizing mood if mood liability is the primary problem. Follow your doctor's advice.