Q:  Son's Lithium Level

My son is currently talking 1200 mg. of lithium.  There was not much improvement until 400mg. of neurontin was added. Improvement was made for about two weeks, then back to bad depression. His Dr. has now prescribed 600 mg. of neurontin with the same dose of lithium - 1200 mg. and has drawn his  blood level after three days at the higher neurontin level. Isn't it more likely that a higher level of lithium is needed. The last time his blood was drawn it was .6l after 10 hours. He takes the lithium and the neurontin twice daily. He is a teenager of 17 years. Help?

Dear Ms. M' -- 
Raising lithium would be an option, until the blood level was closer to 1.0.  But side effects can get worse up there (although not for everyone; but sometimes a doctor might be really cautious about going up there so as not to "blow a good thing" in a young person who might not be willing to take it again after a bad experience with it).  

I'm pretty skeptical about Neurontin having lasting positive effects.  It can be really great for a while; some of my patients made it to almost a year of good response, but only one beyond that and he's cycling still.  As the research too does not support it as a "mood stabilizer", I tend toward the medications that have more recognized potential as "mood stabilizers" and would think about augmenting the lithium with one of those.  However, his doctor might have a specific strategy in mind here that I'm not familiar with. 

Dr. Phelps