Posted by bleauberry on June 5, 2010, at 6:17:14
In reply to need advice from others (incl bleuberry), posted by mommyron on June 4, 2010, at 19:59:39
The title of your post says you need advice. Well, I'm not qualified to give advice. But I can at least think out loud, and maybe somewhere in those thoughts you might find something helpful? Maybe, maybe not, but here goes.
Of the ssris, only Prozac was somewhat helpful and tolerable at the same time. But it wasn't complete, and there is the issue of mood swings. So immediately Zyprexa came to mind. The combination of the two works much better on depression than either alone, and simultaneously smooths out the swings. The combo dramatically increases norepinephrine and dopamine in the mood centers of the brain, which is what Ensam did, but by a different mechanism. If weight gain is an issue, the price you'll have to pay is closer attention to what you put in your grocery cart. Which is in my book, regardless, the number one place to start when treating any chronic illness.
Since Ensam did work, immediately Nardil and Parnate came to mind. Both can be very good for anxiety as well, though I think Nardil is better known for that.
If desipramine made you a zombie, nortriptyline might as well. Maybe not.
I guess the seroquel is probably better than nothing. But if there was any single antipsychotic to take for maintenance, my top choice is zyprexa.
If you are into trying meds from other countries, the antipsychotic/antidepressant Amisulpride could be a good choice. We Americans sometimes display an arrogant syndrome called NIH. That is, Not Invented Here. Some of the meds from around the world have mechanisms unlike anything we have in the US, they have long respectable track records, hundreds of clinical studies, approved and used in many countries, and can be very useful when we run out of options with the limitations the FDA gives us. Amisulpride is a top choice in that category for the symptoms you described. Depression, dysthymia, anhedonia, anxiety, mood swings, it covers the whole spectrum and does so at such low doses there are hardly any side effects.
Since Cymbalta was helpful but the side effects were too strong, there is the possibility of taking it again except at a lower more tolerable dose and then adding another antidepressant to it. I know it sounds weird and would be kind of unorthodox, and some risk if not monitored carefully in the early days, but something like a low dose prozac plus low dose effexor or low dose cymbalta might be considered.
Prozac plus Ritalin? Maybe a tad bit of seroquel or zyprexa along with it to offset any overstimulation if it happened.
It's a tough game. I wish there was an easier way. But hopefully you'll get some ideas. If it were me in your shoes, all of the above would be on my to-do list. The hard part is deciding where to start, what to do first.
poster:bleauberry
thread:949953
URL: http://www.dr-bob.org/babble/20100604/msgs/949974.html