Posted by SLS on March 28, 2018, at 13:14:02
In reply to Re: Cognitive Impairment, lack of motivation, etc., posted by Confusedcius on March 12, 2018, at 8:46:34
> UPDATE: After looking through some of Stahl's Essential's books, it seems that my problem is very much a 'reduced positive affect'. Poor motivation, poor self-confidence, poor attention, etc. all fall under that category. These are all likely due to a Dopamine/Norepinephrine dysfunction as I've suspected. My positive initial response to Wellbutrin XL also confirms that.
>
> So, based on Stahl's recommendations and my own preferences to narrow them down, I've decided to go in this direction for possible combos:
>
> Cymbalta
> Cymbalta + Buspar
> Cymbalta + Modafinil
> Cymbalta + Wellbutrin XL
> Wellbutrin XL + Buspar
> Wellbutrin XL + Modafinil
> Wellbutrin XL + Strattera
> Strattera + Buspar
> Strattera + Modafinil
> Nardil
> Nardil + Modafinil
>
> My current med regimen: 60mg Duloxetine and 20mg Buspirone (10mg 2x day).
>
> Since I've restarted my medication trials, I started on Cymbalta 30mg and then was increased to 60mg after 2 weeks and I've been on that dosage for many weeks. I did not notice an improvement so I requested to add on Buspar and my pdoc put me on 20mg and that's where I've been since 4-5 weeks ago. I will go back to my pdoc in a couple of weeks and my next step will either be A) Increase Buspar dose if no sufficient improvement by then, B) Discontinue Buspar and start Modafinil or C) Keep all dosages the same (best case scenario, would mean I've significantly improved by then).
>
> I have noticed a possible, slight improvement with the Buspar so if I don't receive a significant improvement in the next couple weeks, I'm thinking of increasing the dosage but I'm not sure if higher doses of Buspar target more Serotonin and only lower doses target Dopamine. I don't want to spend weeks increasing the dose and then have it not work, especially since I've read (in Stahl's prescriber's guide) that doses above 20mg are more likely to cause sedation which is counterproductive for my situation.
>
>
> Any insight is greatly appreciated.
Why do you not consider Effexor? Is there any evidence that Cymbalta works better than Effexor? Effexor + Wellbutrin works well for some people. I like Effexor + nortriptyline.
- Scott
Some see things as they are and ask why.
I dream of things that never were and ask why not.- George Bernard Shaw
poster:SLS
thread:1095139
URL: http://www.dr-bob.org/babble/20180212/msgs/1097791.html