Posted by SLS on December 18, 2008, at 10:01:28
In reply to Re: Med name? Deylin? Deplin? » SLS, posted by fayeroe on December 18, 2008, at 9:17:17
> Scott, right now I am on Lamictal and Wellbutrin with Trazadone for sleep.
That is actually a very good combination. Not for you, obviously, but it does show that someone knows what they are doing. My doctor has had much success with Wellbutrin 300mg and Lamictal 200mg.
> When I was first diagnosed with "depression", I was put on amitriptyline and it worked for years. Is it similiar to nortriptyline 150mg.
When the body breaks down amitriptyline, the result is nortriptyline. Nortriptyline is the daughter drug, and appears in the blood stream along side the amitriptyline. Nortriptyline is "cleaner" and more forgiving with regard to side effects. I would think that your chances to respond to nortriptyline would be better than to desipramine, given your history. The average dosage for someone is 75mg. Some people metabolize the drug at a higher rate (rapid metabolizers), and must take higher dosages. However, blood tests assaying nortriptyline are well studied and have yielded the observation that the effective range for blood levels are between 50-150 ng/ml. Even so, this is just a guideline. You really do have to titrate the drug clinically, just as you would with any other drug.
Has Wellbutrin 300mg helped at all? If it has, I would leave it in place and try adding Effexor 300mg or Lexapro 40mg to it, so long as you can tolerate the higher dosages.
Stephen Stahl, MD, PhD has had success with combining a TCA with an SSRI or SNRI. The TCAs of choice are nortriptyline and desipramine, as they are the most noradrenergic (NE) and least serotonergic. I have no impression of the effectiveness of combining Wellbutrin with a TCA, but I do not see why it wouldn't be safe to do so. Unless you are susceptible to seizures or are electrolytically comprimised, there should be no contraindication.
Good luck with your appointment today. If you haven't already considered adding an atypical neuroleptic (antpsychotic), it might be time to discuss this with your doctor. Abilify and Geodon are probably the most antidepressant-like of the breed.
- Scott
poster:SLS
thread:869219
URL: http://www.dr-bob.org/babble/20081214/msgs/869405.html