Posted by bleauberry on December 27, 2009, at 6:46:31
In reply to Re: Nighttime dysphoria and already on meds..., posted by mtdewcmu on December 26, 2009, at 21:58:37
Well, I am relieved. You seem to have a smart plan and know what you are doing. You seem to be in more control of the situation than I was with mine several times. :-)
Back to the original symptoms, I suspect an adrenal exhaustion scenario. The largest dip of the 24 hour period probably occurs when you feel the sinking. If my hunch is correct, Remeron in particular is not doing you any favors, as it is putting additional stress on the already struggling adrenal glands. I know this particular topic pretty well and just thought it would be important to throw it out there in case someone else doesn't.
If my hunch were correct, a norepinephrine reuptake inhibitor holds a strong potential, through feedback loops and artificially boosting norepinephrine, to rebalance the entire network that is involved.
> > I would consider replacing Remeron and Wellbutrin with first choice Nortriptyline, second choice Savella.
> >
> > It sounds like a daily rhythm, timeclock, adrenaline, cortisol thing. Complicated. But norepinephrine reuptake inhibitors can balance that out and reset it over time. Remeron and Wellbutrin are, in my view, likely to be worsening it.
> >
> > If you had your cortisol checked on the Adrenal Stress Index test, it would not surprise me if the 3rd saliva sample of the day (the one you take at the time the sun goes down) is way below where it should be. An NRI will help compensate for that in the short run and restore it to normal in the long run. As will specific attention to foods you choose to eat, but that's another story.
> >
> > The only reason I happen to recognize what you are talking about is because I've had some experience with it myself.
> >
> > What does your doctor say about all this? What is the reasoning behind combining those doses of Prozac and Zoloft? Is he aware of the danger in doing that?
>
> I did not think to mention it, or it didn't seem like as much of an issue at my last appointment. The reason I am taking both Prozac and Zoloft is because I am transitioning from Zoloft to Prozac, and the doctor recommended a cross-taper. It doesn't seem like much, as it has not been causing any typical SSRI side effects.
>
> Well, today I took 45mg of Remeron, and I felt better for the first part of the day. Then I took an extra 20mg Prozac. So that makes 40 of Prozac per day. I actually feel some effects now!
>
> I was thinking about nortriptyline, as I had an initially good experience with amitriptyline when I tried it years ago (for sleep, but it was too stimulating, so I tried taking in the morning). The problem with amitriptyline was that my heart rate went up to about 120 after a few days. Cardiac effects are associated with all tricyclics, so I am not sure if I could tolerate any of them. However, I have read that nortriptyline is somewhat better in this respect. Nortrip is something I'm holding in reserve in case a higher dose of Prozac and Remeron does not work.
poster:bleauberry
thread:930897
URL: http://www.dr-bob.org/babble/20091227/msgs/931077.html