### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
I have a dear friend who has been treated for Major Depression for the past 10 years.Currently, she is in a clinically depressed state (severe).Current meds are lithium, quetiapine,fluoxetine, bupropion, alprazolam, modafinil. She self medicates with ETOH on occassion. Based on your experience, could her current medication regeime be contributing to her current episode, and discuss the safety of this combination of drugs. My question might best be answered by a psychiatrist and/or a pharmacologist.  Any thoughts would be greatly appreciated.

### output:

Hello, All the Chat Doctor. Not necessary to combine all. It is polypharmacy and itself leads to complication: like you don't come to know what is giving effect or what is giving side effects. So, ideally either she should be on bupropion or on fluoxetine; not both. Secondly, the presence of alpha suggest that her anxiety is not controlled and/ or there is ongoing sleep problem. So, may be by increasing the dosage of fluoxetine or bupropion can help...if not, then it would be better to shift her to venlafaxine. Lithium is given in complicated and severe depression...so, it should be continued, but levels are monitored to watch for presence of side effects. Or - if they are below range - one may increase dose if needed. So, ideally, if managed properly, there is no need for modafinil.it has been given for lethargy : which is a part of untreated depression. And would go when things are properly managed. Get her thyroid levels, kidney tests, complete blood counts and ECG (as she is on lithium) and treat if there are some. Issues with tests. Please discuss the above points with her treating team. You have not mentioned dosage of any 