Posted by bleauberry on June 17, 2009, at 19:03:53
In reply to Esc + Bup + Selegiline, posted by West on June 17, 2009, at 11:19:26
> Hello
>
> I need some advice. I'm having trouble grappling with some tough breakthrough depression. Here's what I'm taking:
>
> 15mg Escitalopram
> 300mg Bupropion
> 10mg Selegiline
> 500mg L-Phenylalanine
> 2mg Clonazepam (for sleep but half in day if thing's are hellish)
>
> Every moment feels like a battle
>
> I just took a second 5mg pill of selegiline.
>
> Is this safe? Are there any risks besides hypertension and insomnia given selectivity is retained below 10mg?
>
> It's this or something illegal to change my brain chemistry. I Get insomnia from everything though I know selegiline contributes significantly.
>
> Thanks. You are all in my thoughts.
>
> West
>
Deprenyl is probably safe enough, though there might be some cardiac risk with the DLPA involved.Efficacy is a different story. The only times deprenyl has been proven effective is at high full MAOI doses monotherapy. You have to hunt far and wide to find anyone who finds it helpful longterm at low doses or augmentation doses. It just doesn't happen.
Has Lexapro been longer than 12 weeks? If yes, you have a choice of increasing the dose to 20mg-30mg range, or dumping it completely in favor of another ssri. Don't keep a loser on board.
The same with Wellbutrin. If it has been longer than 12 weeks, it has to go. Don't let a loser drag you down any longer.
Klonopin often causes or worsens depression. You gotta take a look at that. There are other options in that same family.
If you are looking for the norepinephrine/serotonin/dopamine approach, I think you will do a whole lot better with any of the following:
Zoloft+Nortriptyline
Savella
Prozac+Zyprexa
Nardil
ParnateSorry I don't have better things to say. When I see someone on a laundry list of meds and they feel like crap, I can't help but get pissed off at those meds and wonder why in the heck they are still on those meds, and why don't they go with combinations that actually have a huge body of evidence supporting their efficacy???
In the above list, Lexapro has a lot of credibility. Wellbutrin has a fair amount also. But that doesn't matter. If they aren't working, they aren't working, and it is simple as that. Throw the credibility out the window, and look at something else of equal or higher credibility that is different.
poster:bleauberry
thread:901515
URL: http://www.dr-bob.org/babble/20090611/msgs/901588.html