Hello, All the drugs she has been using can be used in treating depression but usually it is.not necessary to combine all.. It is polypahrmacy and itself leads to complication: like you dont 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 alprax suggest that her anxiety is not controlled and/ or there is ongoing sleep problem. So, may be by incresing the dosage of any of fluoxetine or bupropion can help...if not , then it would be better to shift her to venalafaxine. 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, completle 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 drug..otherwise i would have been able to guide on that too. Wish you good luck. Dr. Manisha Gopal MD Neuropsychiatry