A lot has happened since I last wrote. That would make sense, it was a long time ago. I've now moved from effexor & lithium, to lithium and moclobemide (which has to be the worst drug I've ever tried), to lithium and nortriptyline and finally to just nortriptyline. More recently I've discovered that the nortriptyline (100 mg/daily) has been causing problems with my energy level. When I took it in the morning, I was so tired I could barely function I was so tired, when I took it before bed I often can't fall asleep and almost always wake up every hour on the hour after about 5 am. That's not even mentioning that since I've started the nortriptyline I've developped hypomanic-like symptoms. A divided dose just leaves me tired all day and not able to sleep at night. I've put in a request to see a pdoc, because my GP won't touch my meds anymore. I guess once you've tried thirteen different meds with limited success, they don't really know what to do with you anymore.