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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by rovers95 on August 3, 2019, at 14:47:06
I'm only actually 13 days at a therapeutic (> 75mg) amitriptyline dosage, so I'll give it some time yet. But the pattern so far is up the dose and feel a lot better for a few days, then retreat backwards.
If I don't get a response in a few weeks with ami then I'm looking at augmentation options and was hoping for some advice.
Lithium - currently taking 600mg but should I go higher?
T3 thyroid
Buspirone or pindolol
Low dose wellbutrin
Low dose prozac
Lamotrigine - I might be bipolar 2 so there is potential here, but I had no response to riluzole this time around.
Posted by rovers95 on August 3, 2019, at 14:56:59
In reply to Amitriptyline augmentation options, posted by rovers95 on August 3, 2019, at 14:47:06
> I'm only actually 13 days at a therapeutic (> 75mg) amitriptyline dosage, so I'll give it some time yet. But the pattern so far is up the dose and feel a lot better for a few days, then retreat backwards.
>
> If I don't get a response in a few weeks with ami then I'm looking at augmentation options and was hoping for some advice.
>
> Lithium - currently taking 600mg but should I go higher?
>
> T3 thyroid
>
> Buspirone or pindolol
>
> Low dose wellbutrin
>
> Low dose prozac
>
> Lamotrigine - I might be bipolar 2 so there is potential here, but I had no response to riluzole this time around.I'm only actually 13 days at a therapeutic (> 75mg) amitriptyline dosage, so I'll give it some time yet. But the pattern so far is up the dose and feel a lot better for a few days, then retreat backwards.
If I don't get a response in a few weeks with ami then I'm looking at augmentation options and was hoping for some advice.
Lithium - currently taking 600mg but should I go higher?
T3 thyroid
Buspirone or pindolol
Low dose wellbutrin
Low dose prozac
Lamotrigine - I might be bipolar 2 so there is potential here, but I had no response to riluzole this time around.
Forgot one, Trazodone.
Posted by linkadge on August 3, 2019, at 17:31:11
In reply to Amitriptyline augmentation options, posted by rovers95 on August 3, 2019, at 14:47:06
I would first add some zinc and folic acid (if not taking them already). If it was me, I would opt for low dose Prozac as an adjunct.
Escitalopram and amitriptyline worked very well for me.
Linkadge
Posted by Lamdage22 on August 4, 2019, at 0:05:27
In reply to Amitriptyline augmentation options, posted by rovers95 on August 3, 2019, at 14:47:06
Id do wellbutrin or lamotrigine
Posted by rovers95 on August 4, 2019, at 11:15:50
In reply to Re: Amitriptyline augmentation options, posted by linkadge on August 3, 2019, at 17:31:11
> I would first add some zinc and folic acid (if not taking them already). If it was me, I would opt for low dose Prozac as an adjunct.
>
> Escitalopram and amitriptyline worked very well for me.
>
> LinkadgeThanks for this, what doses were you using of both and for how long? Am I at risk of serotonin syndrome with 100mg amitriptyline alongside?
Posted by linkadge on August 4, 2019, at 11:18:07
In reply to Re: Amitriptyline augmentation options, posted by rovers95 on August 4, 2019, at 11:15:50
I was taking 5mg of escitalopram (about a year). Amitriptyline appears to be relatively unlikely to cause serotonin syndrome. For example, it can often be combined with MAOIs when other TCAs can't.
Linkadge
Posted by rovers95 on August 4, 2019, at 11:18:40
In reply to Re: Amitriptyline augmentation options, posted by Lamdage22 on August 4, 2019, at 0:05:27
Great Thanks, have you tried wellbutrin? Guess I'm a bit concerned of increasing anxiety.
Posted by rovers95 on August 4, 2019, at 11:34:18
In reply to Re: Amitriptyline augmentation options, posted by linkadge on August 4, 2019, at 11:18:07
> I was taking 5mg of escitalopram (about a year). Amitriptyline appears to be relatively unlikely to cause serotonin syndrome. For example, it can often be combined with MAOIs when other TCAs can't.
>
> LinkadgeAh great, so I guess I could even look at maois down the line. How much amitriptyline were you on alongside if you don't mind me asking. Also what were the incremental benefits with the Ssri and why did you stop after 1 year?
Thanks again
Posted by Christ_empowered on August 4, 2019, at 14:02:15
In reply to Amitriptyline augmentation options, posted by rovers95 on August 3, 2019, at 14:47:06
hi. what are your problems, now? my first suggestion would be lamictal, but...the titration is so slow, by the time you get up to 200 or so, you'll probably have more improvement from the elavil, anyway. not a big deal, but...personally, im trying to do the whole 'less is more' thing with Rx psych drugs.
buspar might be a decent option...its cheap, generic.
i think it is wise to be concerned about serotonin syndrome, btw. kind of like neuroleptic malignancy syndrome...its one of 'those problems' with the psych drugs that it seems few are warned about...and i dont see any quality data or all that much accurate record keeping on it, either.
wellbutrin, maybe, but...seizures. they do happen. if you have good insurance coverage and an accommodating psychiatrist, i would ask about modafanil or even ritalin or focalin.
vitamin c, b-complex, coenzyme q10, extra folate, zinc, possibly D3, especially if you opt for lamictal...
elavil+perphenazine is still available, as (generic) Triavil. i dont think perphenazine is a good idea if you can avoid it, but if you and the psychiatrist think a more modern neuroleptic is appropriate, and they do informed consent and AIMS testing, etc..
maybe a low dose of abilify or even a tiny dose of risperidone? the risperidone could potentially boost the elavil...but weight gain, metabolic probs, and prolactin elevation would be more of an issue than with abilify and the new D2 partial agonists (I think...).
but then again, buspar might help, without all the neuroleptic risks.
Posted by Lamdage22 on August 4, 2019, at 15:34:06
In reply to Re: Amitriptyline augmentation options » Lamdage22, posted by rovers95 on August 4, 2019, at 11:18:40
Yes, I have. It's a long time ago though.
Posted by linkadge on August 4, 2019, at 16:59:40
In reply to Re: Amitriptyline augmentation options » linkadge, posted by rovers95 on August 4, 2019, at 11:34:18
I went up to 50mg of amitriptyline and 5mg of escitalopram. Adding escitalopram further helped my mood (so that I wouldn't have to go up further on amitriptyline).
I stopped the amitriptyline (bad idea in hind sight) and switched to mirtazapine. The thought was that it would have fewer side effects, which it did, but it was also not nearly as effective.
Linkadge
Posted by rovers95 on August 14, 2019, at 6:23:34
In reply to Re: Amitriptyline augmentation options, posted by Christ_empowered on August 4, 2019, at 14:02:15
> hi. what are your problems, now? my first suggestion would be lamictal, but...the titration is so slow, by the time you get up to 200 or so, you'll probably have more improvement from the elavil, anyway. not a big deal, but...personally, im trying to do the whole 'less is more' thing with Rx psych drugs.
>
> buspar might be a decent option...its cheap, generic.
>
> i think it is wise to be concerned about serotonin syndrome, btw. kind of like neuroleptic malignancy syndrome...its one of 'those problems' with the psych drugs that it seems few are warned about...and i dont see any quality data or all that much accurate record keeping on it, either.
>
> wellbutrin, maybe, but...seizures. they do happen. if you have good insurance coverage and an accommodating psychiatrist, i would ask about modafanil or even ritalin or focalin.
>
> vitamin c, b-complex, coenzyme q10, extra folate, zinc, possibly D3, especially if you opt for lamictal...
>
> elavil+perphenazine is still available, as (generic) Triavil. i dont think perphenazine is a good idea if you can avoid it, but if you and the psychiatrist think a more modern neuroleptic is appropriate, and they do informed consent and AIMS testing, etc..
>
> maybe a low dose of abilify or even a tiny dose of risperidone? the risperidone could potentially boost the elavil...but weight gain, metabolic probs, and prolactin elevation would be more of an issue than with abilify and the new D2 partial agonists (I think...).
>
> but then again, buspar might help, without all the neuroleptic risks.
>
>Thanks, both ability and risperidone gave me akathisia. I'm tempted by lamotrigine, but I didn't respond to riluzole, so that may be a negative indicator of how I will do on that?
This is the end of the thread.
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