Posted by Elizabeth on February 4, 2002, at 12:33:50
In reply to Re: Looking for advice for TRD / anergia » Elizabeth, posted by A0102 on February 3, 2002, at 6:27:14
> I thought Dexedrine sounded like a good idea because of it's obvious "getting me out of bed" properties, but for other reasons as well.
Sure, since you've had past success with stimulants I think it's a fine idea. I think that you should give Effexor alone a chance to work, just so you'll know what's doing what. You may even find that you don't need a stimulant with the Effexor. I'm not sure about amphetamine doses; you'll need to work that out with your doctor. Concerta is another thing you might consider if you want something long-lasting.
> I also wanted to add Remeron to insure that I don't have trouble falling asleep after taking a stimulant.
A fine plan, but again, I think you should wait to see if you need it! When I was taking a stimulant (Cylert -- weaker than amphetamine, but lasts about 12 hours), I found that it helped me to regulate my sleep-wake cycle: I'd take it in the morning and be alert during the day, then gradually get tired just around the time I needed to go to sleep. Sleep regularity isn't something that comes easily to me, so this was pretty cool.
> I do take Sonata on occasion because a lot of the time I keep myself from going to sleep trying to figure out how to catch up on what I've missed during the day. My concern with continuing to take Sonata along with a stimulant is relying on them to regulate my sleep cycle and eventually building myself up to a crash.
Why do you think that wouldn't happen with Remeron too? I'm not sure about Sonata, but I know that Ambien often continues to work for a long time without tolerance (I took it just about every day when I was on Nardil and had no problems with tolerance or dependence).
> I have not tried an MAOI yet due to the fact that my pdoc says I would likely have migraines with them similar to my experience with Wellbutrin.
I don't see any reason to assume that. They're completely different drugs. As Spike pointed out, MAOIs are actually used to prevent migraines (or they used to be, anyway). It's *possible* you'll have migraines on them, but I think the risk of that is small. Obviously since you're trying Effexor, MAOIs aren't the thing to try right now, but it's an idea to keep on the back burner, and I think it's something you shouldn't rule out.
> I'm not sure exactly how he came up with that or why he decided to go with Effexor. Effexor has a 25% rate of occurance of headache!
Migraines are a very specific type of headache, not at all the same as the tension headaches that most people have from time to time. Anyway, headaches occur a lot in the general population, so placebo also has a high headache rate!
> This one seems to be caught up in running through the list of every commonly used med before trying anything creative to target my specific symptoms. I'm not sure if that's good(i.e., patience) or bad(i.e., incompetence), but all I know is that while he's busy with that I'm dropping out of classes and losing my job.
Patience is important (for both of you), but he also needs to choose medications rationally, with thought for your particular symptoms. Why not ask him why he chose Effexor in particular (and generally make a habit of asking for an explanation whenever he recommends a new med).
-elizabeth
poster:Elizabeth
thread:92489
URL: http://www.dr-bob.org/babble/20020131/msgs/92825.html