Q. I am currently on 10 mg. of Prozac and just started 10 mg of Buspar a week ago. After starting the Prozac two months ago, I became very agitated and restless, my bulimia and worsened, I got two speeding tickets in a week and I started stealing small things. I have calmed down somewhat but I still crave sugar, get so restless I can't stand it and get so angry I want to break things. I came off Celexa after taking it for nine months because my depression started to worsen and I was getting too irritated. When I increased the Celexa, all that would happen is I became so tired and sleepy, I literally couldn't keep my eyes open. That was only on 20 mg.

I have been on Paxil, Zoloft, and Luvox, all low doses, which all helped with anxiety, but all made me way to sleepy. I have also been on Effexor which made me extremely agitated, and Wellbutrin which did nothing. I have also taken Depakote which made me cry all the time, and take Zyprexa and Risperdal from time to time when needed which has been a lot lately. The problem with those is that even on 50 mg of Risperdal, I can't function at work. I can't focus or remember things. My depression is still bad and I feel like a Zombie at times. My doctor thinks the Buspar might help cut the agitation of the Prozac but I am doubtful. I need help and I don't feel it is out there. I am tired of the medications. I can only tolerate low doses and they only help a little and only for a while. Any suggestions would be appreciated.

A. A couple ideas to consider for treatment. There are a number of individuals who get sedated on SRIs. There is essentially no difference between any of them as far as efficacy, so get back on the one you like best. If Celexa was best tolerated, other than sedation, retry it. My own experience with Celexa is that people require 60-80 mg/day to treat BPD. As always, dose until carbohydrate craving goes away. The sedation can be tackled in two ways.

First is to use a stimulant with the SRI. I like Adderall, which is a sustained release preparation of amphetamine salts. Ritalin and Cylert also are good, but Adderall seems to do best. If cocaine use or drug abuse has been a problem in the past or if anxiety is high, we are finishing up some work with Provigil. This is like an amphetamine in its ability to mentally energize, but is much less problematic than the aforementioned stimulants. Provigil, unfortunately costs a bundle, but seems to work very well without tolerance, abuse, or increases in anxiety.

Also, if you are not obsessive compulsive, you may want to try using Serzone as 500 or higher mg at bedtime. This is great for anxiety, and a good antidepressant. Its efficacy is lower, however, if you have OCD. Again, titrate until sweet tooth is gone. Average dose in BPD was about 525 mg/day in our studies (range of 450-1000 mg/day).

Finally, you may actually do better on higher dosages of Celexa than lower from a sedation standpoint. Some folks get sedated at low but not high dosages. If these do not work, let me know.