Posted by bleauberry on January 15, 2009, at 16:58:34
In reply to Ixel [Milnacipran] again...But Initial Moodiness?, posted by Mishal on January 15, 2009, at 9:31:43
While 100mg is a valid dose as monotherapy, it sounds to me like it could be much too high combined with two other meds that are already pro-norepinephrine. Maybe if you titrated up to that dose over a period of several weeks or months. But right from the start in one big bang, I dunno.
Norepinephrine overload, ya know, too much too fast? Just a thought.All of the combinations using Ixel I have read about at pubmed and other places combined it with serotonin agents such as Paxil, Zoloft, or Lexapro, but never another NE drug. It has also been combined with Zyprexa or Risperdal. Risperdal in particular had a stunning effective rate in a small group of treatment resisters. I do recall seeing someone at a drug rating board that combined 100mg Ixel with 120mg Cymbalta and 300mg Wellbutrin. Even that combination was much more on the serotonin side of things than yours.
Ixel monotherapy at 100mg to 150mg judged at 12 weeks actually has a phenomenal rate of response and remission, so maybe no need to combine it with anything.
Ixel, as with any other reuptake inhibitor really needs a full 12 weeks for judgement. There is no way to make a fair assessment at 2 days, 2 weeks, 4 weeks, or even 6 weeks.
Maybe try bringing the dose way down and keeping your eye on a goal 3 months out, and the possibility of reducing or eliminating the other meds as Ixel takes over week by week, month by month.
I know we all want it now and fast. It just aint that way.
poster:bleauberry
thread:874131
URL: http://www.dr-bob.org/babble/20090104/msgs/874176.html