Q. I have been diagnosed with both Bipolar Disorder and BPD. I am currently taking 300 mg of Serzone, 50 mg of Seroquel, 400 mg of Neurontin, and half a mg of Klonopin. I tried the Serzone at 450 mg for about a month and saw no improvement.

Next, I tried taking Effexor XR. I took one 37.5 mg capsule in the morning. At bed time, I could not sleep at all. I was wide awake all night and kept feeling these weird hot/cold sensations in my body. It was like I was freezing and on fire all at the same time. I could not get comfortable. Needless to say, I did not take anymore of it.

I tend to be very unmotivated, avoidant, depressed, anxious, irritable, and obsessive, Even on these medications. Basically, I'm not getting any better. I need something to bring me out of this depressive rut that I've been in for so long.

I tried Paxil, Prozac, and Zoloft in the past, and they made me worse ( I took them with an anti-anxiety med and not a mood stabilizer). I did best on Nardil but because of obvious reasons (weight gain and diet restrictions), I don't want to take it again. I wonder what is left for me to try? I'm a person of very limited means and cannot afford insurance.

  A. Effexor can increase anxiety in a few percentage of people for the first few days an individual is on it. All serotonin increasing medications also can make sleep worse for days to weeks. I would suggest retrying the Effexor XR with 100 mg of Serzone at night, and use a sleeper at bedtime. You can use Trazodone, Lorazepam, Ambien or Sonata--whichever works best for sleep. If sweating is a problem at night, Levsin can be used at bedtime to get rid of this symptom.

Effexor may not work, but it works in more people than anything else.

Serzone usually needs to be at 500-600 mg at bedtime to work, so if you are still on it, try using a higher dosage before discarding it entirely. Talk with your doctor before trying these suggestions.