Darkeyes - This is a tough one really. Amphetamines like ADDeral™ and Dexedrine™ can counteract the mood stabilizing effects of lithium.

An option would be to use a newer drug that is indicated for narcolepsy, modafinil (Alertec - CDN; Provigil - US). The only problem with is a doctor will probably balk at the idea. Modafinil is too new to most docs and using a drug that they have never used before, especially for an off-label purpose, may make them think twice about using it in a situation where stimulants usually provoke mania.

I am not positive that modafinil will not counteract the lithium, but I have seen it used in a couple of incidents. I do not know any of the long term problems arising from this therapy, or even if the people who were taking the combination are still.

Low dose Ritalin™ (methylphenidate) is also an option, but I have never seen it used with lithium, personally.

Wellbutrin™ (bupropion) may be another option. It is a stimulant with a structure very close to the diet pill Tenuate™ (diethylpropion) and may be what you are looking for. The doc may be more receptive to this drug than to others. There is a very low risk of manic switch with this antidepressant when compared to others.

The only other suggestion is to chew coffee and keep it between you cheek and jaw (although I truly do not endorse this method).

I think that you have to stress the anergia to your doc. Ask what he is going to do about it, and it is an unacceptable side effect of the treatment &/or disorder. Pester him during the appointment until he does something about the situation.

Sorry that I cannot be of more help. - Cam

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