Q:  Prozac Isn't Working-Suggestions?

Dear Dr. Phelps,

I am in a depression at this time, not wanting to get up and do much.  I've been on 900 mg Lithobid, 50-100 mg Trazedone for sleep, and 20 mg Prozac.  I wanted to stay on the low side of Prozac, 20 mg, but found it wasn't working so I tried 30mg but it still wasn't working, so I tried the 40 mg over the last 2 mos.  I have been basically feeling fatigued, and can't get a hold of my psychiatrist till the 18th.  My concern is the Prozac isn't working anymore.  I've had difficulty finding an antidepressant in the past and this was the 3rd time I've been on Prozac.  I've tried other antidepressants, Remeron, Paxil, Celexa, Zoloft, Serzone, Wellbutrin, for newer drugs.  Is there anything that you might suggest.  And Also since I was on Depakote, and it didn't work by itself, increased bilirubin enzyme, have you heard of any success stories of it in combination with Lithium. Or is there anything you might suggest as a mood stabilizer for someone with Bipolar II.  I've been on Lithium for 20 years.   Thanks,  Marc


Dear Marc -- 
As you may have read, there are quite a few mood experts who think that the way out of your cycling into depression is to get rid of the antidepressant, ironically.  You might need additional mood stabilizers.  Going back to Depakote is potentially going to be a problem after that bilirubin increase.  You might have to look at alternative mood stabililizers like Trileptal and lamotrigine, following the liver enzymes again.  

Dr. Phelps