Posted by LouisianaSportsman on May 12, 2012, at 18:41:02
In reply to Re: Suggestions for meds augmentation? (BP2, GAD, MDD) » bleauberry, posted by SLS on May 12, 2012, at 13:47:18
It may sound like I am responding to SLS only, but I have tried to include everyone's input!
I have not had any psychotherapy, unless reading books counts lol. My mom takes Cymbalta and my dad takes Pristiq. My grandmother takes Prozac. They all have unipolar depression; whereas I have a bit more going on.
As far as your anticonvulsant suggestions go; no, I have not tried a carboxamide nor Topamax. I would be more interested in a target dose of 100mg. Topamax, however. I know its supposed to help you lose weight, but Im just slightly overweight and wear a size small/medium so its not the end of the world. Lamotrigine has been awesome.
I dont like the idea of blood tests, so I would like to avoid TCAs and lithium salts, but clomipramine as monotherapy does seem attractive.
I have not tried a MAOI. I think Parnate would be very good, but Im not sure if my PDOC would risk it with my Adderall which has been very effective. Emsam patch? I have good insuranceSo based on the fact as that I dont like blood tests and I doubt that my PDOC would want to do concomitant dosing of anything with an SSRI. I also just dont like the idea of an AP to be honest, unless absolutely needed. I really don't want to go back to a SSRI/SNRI either since I was so proud to get off Zoloft and I very occasionally want to take acid (I see nothing wrong with it.). So, based on your suggestions and my criteria, it leaves: Effexor (my dad responded well), Trileptal, and Topamax.
My dad has responded tremendously well with Pristiq. Do you think that or the XL would be good to try next? If it doesnt take care of all the symptoms, then I would consider augmenting with, in order of preference: Seroquel XR (especially if my dose of amphetamines are raised), Abilify, Geodon, and Latuda. Ive read that Abilify (know anything more about this, Phillipa) and Geodon raise anxiety in some people (probably a chance with all APs) Wellbutrin did this for sure.
I do want to give memantine a shot in the future and I have been wanting to for awhile now. My PDOC is all about one thing at a time, but hes not so strict straight to the book that he wouldnt prescribe it I dont think. I also dont think he would be so quick to prescribe Parnate although I dont think it is the worst of ideas. I also not see him prescribing Savella unless we try out more alternatives. I know nothing about Savella? Why do you think it would be a good option, bleauberry?Are blood tests absolutely needed for all TCAs? Ive read that is very important with nortriptyline.
Ron1953, Klonopin actually did cause one impulsive episode and I feel like that was it. Subjective, yes, but I just got that feeling. I like the idea of a benzo with a long half-life because I really want to eat a benzo everyday. My PDOC is all PRN about it but then he prescribes me #60. Switch to diazepam?
In terms of tweaking the opioid system, I believe bleauberry was referring to my prior opiate addiction. I know that venlafaxine is related to Tramadol. I was taking buprenorphine (from the street) and it was not the worst antidepressant, but I don't want to continue that nor do I think I would get it prescribed since I'm no longer addicted to opiates.
So far, Im thinking Trileptal or Topamax. Does anyone think it might be better than Effexor for my symptoms?
(Des)venlafaxine monotherapy seems to be most likely. Is it true that SNRIs are more safe for Bipolars? I doubt itd increase anxiety like Wellbutrin. Its effects on NE are so ridiculous low that the term SNRI is a bit O_o to me. If not effective, like I said, continue to augment. Do you think that venlafaxine would be more effective than Trileptal or Topamax? Would about raising the dose of Lamictal? My PDOC says he never goes above 300mg.
Thanks for all the input!
poster:LouisianaSportsman
thread:1017746
URL: http://www.dr-bob.org/babble/20120508/msgs/1017790.html