So after a genetic test which showed me to be a slow metabolizer of Lexapro (it is broken down by 2 enzymes, the cyp4,5 one is slow in 90% of Caucasians (and I am normal for that), and my cyp 19 variant is ineffective (only something like 4% of Caucasians have the version I have)) the pdoc told me to drop the lex from 20 to 15 over two weeks, and to take Deplin (methyfoliate, which is needed to make neurotransmitters) since I am heterozygous for the gene (one works to convert folic acid to methyfoliate, the other does not, so I might be an inefficient converter),and take omega fatty acids, specifically to get the EPA portion for mental health and DHA for general health. I also can increase klonopin to deal with anxiety, and have done so lately, taking a .5 mg in the morning on waking rather than .25 since my anxiety/depression is worst in the morning. I also still take .5 at night to sleep and .25 around 4 in the afternoon. I find I am really sleepy after taking the morning .5, not that I am a ball of energy in the morning anyway. It also does not help depression, just tones down the anxiety some. School is about to begin, and I want to get back to work but I dread it, and am having a hard time overcoming that fear. I'm also disappointed that I've been fighting this since January with only modest success at times, and had to miss work last semester. On top of that I lost both my parents and a friend during this time, but I can't change that, I just want to be better at this point. I think this pdoc (my third) may be willing to change meds later on, perhaps by cross tapering to something else, but after my scary experience with Saphris (one pill dropped my blood pressure to dangerously low levels so I passed out and I had to go to the ER and get IV fluids) I'm sure she will proceed with caution. I know she has patients who do well on Cymbalta, among other things. I brought up the idea of trying Zoloft as it worked twice before and it has been years since I took it so hopefully I have not developed resistance to it. And to add to my stress the bloodwork from the ER said I was slightly anemic and had low blood protein (including albumin), however I keep reminding myself they put IV fluids into me before taking blood so maybe that diluted those constituents, and in any case I did a followup blood test that hopefully my regular doctor will have when I see her tomorrow. So among my many questions, one would be how much klonopin do most folks take to keep anxiety at bay for the regular users of it, and is there a way to minimize the fatigue. If I can find an AD that works well, I will taper off of the clonazepam like I did years ago, but right now I seem to need it as the lex is not addressing stuff the way it did for several years, and I am really heartbroken over that because it was a good med for me (at 10 and even 5 mg) before.