Posted by SLS on September 4, 2009, at 16:40:03
In reply to Re: My medication history 1994 to 2009 » SLS, posted by doxogenic boy on September 4, 2009, at 14:29:52
> > Hi.
> >
> > I wrote a long post in response to yours, but lost it.
>
>
> Thanks for your work with it.
>
>
> > To summarise:
> >
> > Keep the tianeptine and escitalopram since they are working for you.
> >
> > 1. I wouldn't bother with Wellbutrin again at this juncture. It will probably treat you the same as it has in the past.
> >
> > 2. You could try adding Remeron right now and use dosages between 45-75mg. Most doctors allow their patients to languish at 30mg. This is silly.> Can Remeron work with my current combination when the somewhat similar mianserin (Tolvon) up to 180 mg in combination with paroxetine 60 mg (spring 1996) didn't work?
Ok. Forget Remeron.
> > 3. It sounds like you might be a tricyclic responder. Switch to a TCA with a better track record for treating depression. You could taper the trimipramine gradually while titrating drugs like amitriptyline, doxepin, or nortriptyline. Nortriptyline does not increase anxiety in most people.
> OK.
> > 4. You could try adding low-dose lithium in the dosage range of 300-600mg. You will know within two weeks whether or not it will be of any value. For those people who are use it as an augmenter of antidepressants, it can work as soon as a few days.
> How does it feel, if low-dose lithium works, as augmenter of antidepressants? Does it work against anxiety, anhedonia, worrying and does it make you feel calm and/or more motivated?If it works, you should find that most of your symptoms improve, including anhedonia and motivation. It should also reduce your worrying and anxiety, as long as those things are part of your depression, and not a separate set of disorders. One caveat: You might not see improvements in anhedonia and interest right away. Energy and the ability to initiate activities seem to improve first. I can't make any guarantees, of course, but if you hit the right targets, you should find all of your symptoms improve.
> I tried lithium in 1994/95, about half a year, then I had a manic-depressive (bipolar) diagnosis (it was replaced by a recurrent depressive disorder diagnosis about ten years ago).
I have tried high-dose lithium several times in the past to no avail. It was only when I discovered the other drugs in my treatment regime first that lithium produced a pronounced antidepressant effect. If lithium is not combined with the right adjunct drugs, it may not help.
> My blood levels was measured, so it was in the therapeutic window for bipolar patients.
> I felt indifferent, and except of the first two months, I had a "stable" depression and it made me indifferent. I felt free and better when I discontinued it. But a low-dose lithium treatment may be better, even with my bad experiences?I feel crappy at 600mg. I feel great at 450mg. The higher dosages make me feel "washed out" and unmotivated. Even more depressed.
> OK. I have heard that a lot of people here where I live have found quetiapine (Seroquel) helpful.
Each person has a unique neurobiology. I have seen Seroquel make an enormous difference in one person, and make another dysphoric and irritable. If you can get past the initial anxiety, insomnia, and feelings of restlessness, Abilify might be worth trying. It seems to stabilize dopaminergic neurotransmission. Geodon is another AP that has shown antidepressant properties.
> It <Seroquel> has both hypnotic, anxiolytic, antidepressive and mood-stabilizing properties, and it has worked like that for me, to some extent. With all my medication trials, it seems that keeping meds that have some effect, is the best I currently can reach.
Keep the Seroquel. If you ever become interested in Abilify or Geodon, you can simply add them to Seroquel for a quick trial. You should know by two weeks whether the new AP will be helpful.
> I have a partial response to my current mix, and even though that still is bad, it is heaven compared to the worst anxiety/depression period August 2004 to December 2006.
I understand completely. You don't have to settle, though. You simply try to build your treatment around the core of drugs that you already know help. In my mind, there are two types of core treatments:
1. Serotonin reuptake inhibitors
2. MAOI without serotonin reuptake inhibitors.With MAOIs, you have limitations as to what you can add to them. This means that you can't use any drug with substantial serotonin reuptake inhibition. You can combine some tricyclics and Wellbutrin with MAOIs. With either core treatment, you can begin to try adding APs (with the possible exception of Geodon), lithium, stimulants, dopamine agonists, buspirone, etc.
> A problem I still have, is that I am very depressed the first half or 3/4 of the day and have many mood swings each day (not hypomanic, just depressed/anxious and less depressed/anxious)
You sound like a tricyclic responder. I would try adding a TCA to the SRI drug you feel helps the most. You can then add low-dose lithium if the results of the TCA trial are not robust. Keep the TCA, though, at least until you try adding lithium to it.
- Scott
poster:SLS
thread:914853
URL: http://www.dr-bob.org/babble/20090902/msgs/915738.html