Posted by SLS on November 6, 2001, at 11:40:09
In reply to Re: dopamine receptor supersensitivy » SLS, posted by JohnX2 on November 4, 2001, at 13:49:24
> Any luck with your treatment path?
> Are you steady with your current
> meds?
Things are pretty screwy.1. I tried unsuccessfully to reduce my dosage of Lamictal. It seems I need 300mg. to receive benefit from it. However, I am suspicious that it is responsible for some cognitive blunting and memory impairments. It might also be responsible for my inability to take moderate dosages of atypical neuroleptics without developing unacceptable cognitive disturbances. Otherwise, these drugs do help me. Lamictal was definitely responsible for a similar state when I raised my dosage of Parnate above 40mg. This state disappeared upon dosage reduction and re-emerged upon increase. When I more recently reduced the dosage of Lamictal to 200mg., I felt as if some of my "old" familiar self reappeared. This was a good thing, I think. Maybe I can finesse the dosage around 250mg.
2. Adding Effexor to nortriptyline 100mg. produces a "brain-fog" that does not seem to be mitigating with time. Otherwise, it probably helps a bit.
3. No single dosage of nortriptyline seems to work steadily. It does produce a mild and necessary improvement at times, but I must keep changing the dosage to maintain it. Before adding Effexor, 100mg. of nortriptyline was pretty good, but still somewhat variable. I lost all benefit at dosages of 75mg. and 125mg. Now, any therapeutic window that exists lies between 25mg. and 50mg. I become severely depressed at 100mg. Perhaps this is due to a pharmacokinetic interaction as both Effexor and nortriptyline are substrates of cytochrome P450 2D6. I might go for a blood-level, but that might only be of heuristic value.
4. Adding Remeron exacerbated my depression after only one 7.5mg. dose. I didn't take a second. My doctor wants for me to try it again once my Lamictal experiment is concluded and I am stabilized on a steady regimen. I might not find such a stable regimen unless I switch from nortriptyline to another tricyclic. Imipramine would be my first choice for efficacy, but it causes me to gain weight and produces some memory impairment and possibly other cognitive disturbances. Although desipramine is milder with regard to these side effects, its antidepressant effects are inferior.
5. The use of imipramine, but not desipramine, makes it very difficult to add Nardil. Since Nardil is probably my best choice to use in place of Effexor, this becomes a real obstacle. Two years ago, I tried to add Nardil to imipramine 300mg. When I reached 45mg., I could not stand up due to hypotension and I had to crawl to get from place to place. It was almost impossible to initiate urination. I was scared that I would have to go to the hospital to be catheterized.
6. My situation pretty much sucks. I like challenges, but...
Thanks for asking.
:-)
- Scott
poster:SLS
thread:82845
URL: http://www.dr-bob.org/babble/20011104/msgs/83333.html