Posted by Chairman_MAO on November 1, 2005, at 9:08:06
In reply to Treatment resistant depression, posted by Girlnterrupted on October 30, 2005, at 9:57:54
My own personal no warranty algorithm for treating depression:
Drop all medications except necessary hypnotics, etc.
Get to 1mg/kg phenelzine. Give that a 4-8 week trial. If no result or inadequate response, try the following:
a) TCA/NE uptake inhibitor
b) DA agonist
c) psychostimulantsIf no rseponse after that, add opioid (buprenorphine is preferable, the easiest to get, one cannot OD on, is a kappa antagonist--many reasons why it is best for psychiatry)
If no result, add memantine, riluzole, or lamotrigine. Lithium can be considered here. If no result, add a dopamine agonist such as cabergoline 2.5mg/day.
For anxiety, alprazolam & adinazolam are the best benzos for depression, followed by clonazepam in some cases. Others can be too depressiogenic.
NOTE: at any time, tranylcypromine 0.7mg/kg (normal dose) or 120-200mg/day (high dose) can be considered (or isocarboxazid 50-80mg/day or selegiline 60-80mg/day) as the MAOI of choice.
poster:Chairman_MAO
thread:573337
URL: http://www.dr-bob.org/babble/20051031/msgs/574097.html