Posted by linkadge on April 17, 2010, at 20:59:52
In reply to Mix of meds - don't seem to be working, posted by tonyz on April 16, 2010, at 11:32:57
Hmm. I've always wanted to try a nortriptyline / cipralex combination. I've heard this is particularly effective.
It sounds like you are on a lot of meds. What is the lithium for? Depression? Lithium can sometimes cause insomnia (believe it or not)
You might experiement with 7.5mg of remeron. Some people find that 7.5 was actually more sedating than 15mg.
The other thing too is that you are on 3 meds that (rem,ser,nor) which have 5-ht2 antagonist / antihistamine effects. It could be that this pathway for sedation is exhausted. Sometimes too much 5-ht2 antagonism can cause paradoxical excitation and or obsessive thought patterns.
Some thoughts.
1) to pick the best of nortriptyline, seroquel, or remeron.
2) reevaluate the use of lithium (unless bipolar disorder is present). Or try lower doses earlier in the day.
3) possibly add a SSRI (lower dose?) with a few extra benzo's as needed for startup anxiety?
4) Additionally, 5-htp might be a useful adjunct. 25-50mg in the midday.
Say.....seroquel + lexapro + benzo's (or)
nortriptyline + lexapro + benzo's (or)
nortriptyline + 5-htp + benzo's
If you can get something to help nail the depression, usually the insomnia lifts on its own.The mood and insomnia are always a catch 22. It just seems that you are on a lot of sedating / depressing type of antidepressant medications. Remeron made my depression worse and its sleep inducing effect wore off. Same with seroquel. Nortriptyline wasn't bad, but it didn't help the core syptoms of my depression.
Linkadge
poster:linkadge
thread:943564
URL: http://www.dr-bob.org/babble/20100416/msgs/943762.html