bipolar disorder, Dr. Paul Markovitz  Q. Eight years ago I was diagnosed with OCD and Dysthmia and was on a steady course of Zoloft at 150 mg daily for six years. This was somewhat effective at controlling both.

Two years ago I had a serious depression with panic attacks for which my Dr. prescribed Paxil up to 80mg.. This made me really jumpy to the point of needing to be discontinued.

For the last year and a half I have been taking lithium at 1200 mg daily to control mood swings, being diagnosed with Bipolar 2.

Since that time I have been on several anti depressants, Prozac up to 120 mg which worked for the depression but did nothing for OCD, Clomipramine which was showing great promise for the OCD but the side effects were intolerable, Luvox 300 mg which is somewhat effective at controlling the OCD but not at depression. The Luvox was then combined with 150mg of Effexor XR. This as only mildly effective at controlling depression. I asked about going higher on the Effexor but my Dr. was concerned about going any higher with two concurrently prescribed SSRI's.

The doctor at the mental health clinic I attend has just changed. He is not as available as the last. With current cutbacks to our healthcare system, (Ontario) I am lucky to be able to consult at all due to a shortage of psychiatrists. Likely I would be able to see him again in early February. This left us discussing the next two trials of medication.

I let the doctor know that I did not feel the Effexor was working effectively for the depression. He has agreed to try something else and has suggested Risperidone to be combined with the Lithium and Luvox which will be increased to 400 mg immediately. This increase will join a gradual reduction of the Effexor. If this new combination of Risperidone and Luvox doesn't work plan B is to try a higher dose of Zoloft.

This whole thing has left me tired and confused. Any information you could share would be helpful.

Have you heard of this combination drug therapy. It seems a bit different because I have read that this drug is an anti-psychotic. Could Wellbutrin be a worthy attempt as my concentration seems to jump quite a bit and I read it was effective in controlling this.

  A. Zoloft worked before and may work again. I shoot for a serum sertraline level (Zoloft level) of 180 ng/ml. The level must be measured between 6 and 8 hours after taking all you Zoloft in the morning. So, if you are on 200 mg in the AM for at least 5 days, and get a level checked, it should be 180 ng/ml. If it is less than this, you need to increase the dosage. Since Zoloft is linear, if it comes back at 120 ng/ml, you will need 300 mg/day. If it is 80-90 ng/ml, you will need 400 mg/day.