Posted by SouthernFarmer on October 16, 2016, at 12:42:46
In reply to Re: Doctor thinks I need a phenylpiperazine? Help!? » SouthernFarmer, posted by SLS on October 15, 2016, at 17:25:47
> What is the Klonopin and Gralise for?
>Anxiety. He said the Klonopin can help with mood too?
> What is the Nuvigil for?
>Energy-- he said it would help wake me up from the Belsomra.
> How do you know that Deplin is still providing relief?
>I have no idea; it may be placebo.
> Belsomra and Nuvigil might antagonize one another with respect to the orexin system.
>He says they work together?
> I have seen only a few people profit long-term to Mirapex. Are you sure that it is really helping? If energy is a problem, you might do better to use Vyvanse or Focalin. However, if Mirapex is producing unambiguous improvements in anhedonia, it is probably worth keeping. I'm not a big fan of DA pure agonists, though. I'm not sure why. I guess I don't like seeing dopamine receptors downregulated.
>Interesting. But I have had problems with addiction in the past, solely with alcohol and pain pills tho, so he is going far out writing what he is writing to me and does a urine screening sometimes on me. I doubt he'd write for an amphetamine, maybe a Ritalin thing.
> I hope you don't get too angry with me: Even though I'm a big proponent of polypharmacy, I can't help but to think that your treatment regime has become a bit messy. My concern is that you might be experiencing cognitive impairments that manifest as brain-fog or a "zombie" effect that are preventing you from increasing the dosages of some drugs; Lamictal and desipramine in particular.
>Maybe I need to taper off the desi?
> I have just a few comments, although they might not be relevant in your case:
>
> 1. The dosage of Rexulti is rather high to treat depression. It might be blunting your affect or giving you brain-fog. 2.0 mg/day should be enough in most cases.
>It didn't seem to do much at 2.0mg just like Abilify didn't do anything until 15mg and I was on 20mg./day.
> 2. The dosage of desipramine is low. If you can tolerate it, you might consider going to 200-300 mg/day.
>May not even need it? Or try nortrip.
> 3. You might try switching from desipramine to nortriptyline. It is milder with respect to side effects, and not as much of a problem with respect to sexual function.
>I'll bring this up. Thinking I don't need a TCA. Prolly need less drugs.
> 4. Brintellix is a serotonin drug that is known to enhance cognition and should not produce brain-fog. I don't think sexual side effects are a problem.
>I'm interested in it.
> 5. Lamictal dosage is lower than what most people need to glean its full antidepressant potential - 200 mg/day. How long did you stay at 150 mg/day before returning to 100 mg/day? I found that the "zombie" effect or brain fog was only temporary.
>I went to 250mg -- found it dulled me and cognitively blurred me, but the lower dosages seemed to give me energy and an antidepressant effect.
> I have seen bupropion + lamotrigine + aripiprazole work very well with someone who has unipolar depression and someone else with schizoaffective disorder with depression. Prior to discovering which drugs were working, they had been on very complicated treatment regimes.
>Basically what I'm on except I'm on Rexulti instead of Abilify.
> I have been fortunate in that my doctor and I have both contributed to a treatment that seems to be working. I have worked with each drug separately to determine its necessity and the lowest effective dosage. Reducing the dosage of any one drug causes me to deteriorate. Going any higher in dosage of some drugs produces unnecessary side effects without further benefit.
>I'm afraid, but ready to make some moves-- tapering off things, but I need something primary like a SSRI/SNRI to really get me out of this slump-- might try Trintellix.
>
> - ScottGood advice. Thanks!
poster:SouthernFarmer
thread:1092616
URL: http://www.dr-bob.org/babble/20160928/msgs/1092631.html