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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 3 to 27 of 36. Go back in thread:
Posted by gman22 on September 18, 2022, at 7:20:42
In reply to Re: remission » gman22, posted by SLS on September 17, 2022, at 21:41:29
I asked my dr for that after coming on here and seeing a post about Ken Gillman. I consulted him via Skype and he recommended these 3 meds together.
50mg sertraline
50mg nortriptyline
56mg concerta (methylphenidate)I've also seen evidence for methylphenidate as successful monotherapy in depression
Posted by SLS on September 18, 2022, at 11:10:14
In reply to Re: remission ))SLS, posted by gman22 on September 18, 2022, at 7:20:42
Thanks.
Posted by Jay2112 on September 18, 2022, at 16:13:14
In reply to remission, posted by gman22 on September 17, 2022, at 18:10:26
Awesome!! I had a similar experience. I personally think the Zoloft works for many because of it's dopamine reuptake properties.
Best,
Jay
Posted by undopaminergic on September 19, 2022, at 7:39:53
In reply to Re: remission ))SLS, posted by gman22 on September 18, 2022, at 7:20:42
> 56mg concerta (methylphenidate)
>You mean 54 mg, right?
> I've also seen evidence for methylphenidate as successful monotherapy in depression
>It did work for me, substantially or even better. It relieved my apathy and my depressive thinking (including suicidal ideation). It was still only a partial response, however -- I did not achieve remission.
The only remission I've experienced since the onset of depression in the end of 1999, is the remission that was part of my first (hypo)manic episode.
-undopaminergic
Posted by Jay2112 on September 19, 2022, at 12:18:28
In reply to Re: remission ))SLS, posted by undopaminergic on September 19, 2022, at 7:39:53
> > 56mg concerta (methylphenidate)
> >
>
> You mean 54 mg, right?
>
> > I've also seen evidence for methylphenidate as successful monotherapy in depression
> >
>
> It did work for me, substantially or even better. It relieved my apathy and my depressive thinking (including suicidal ideation). It was still only a partial response, however -- I did not achieve remission.
>
> The only remission I've experienced since the onset of depression in the end of 1999, is the remission that was part of my first (hypo)manic episode.
>
> -undopaminergic
>Do the mood stabilizers not work for you? Have you tried combining Ritalin with carbamazepine? Amphetamine with carbamazepine has worked unbelievably for me, when I was at my absolute worse. I just thought since Ritalin worked for you, this combo might work.
Jay
Posted by Roslynn on September 19, 2022, at 14:49:04
In reply to Re: remission ))SLS » undopaminergic, posted by Jay2112 on September 19, 2022, at 12:18:28
>Amphetamine with carbamazepine has worked unbelievably for me, when I was at my absolute worse. I just thought since Ritalin worked for you, this combo might work.
>
> Jay
>
Jay, is your diagnosis unipolar or bipolar 1 or 2?Thank you,
Roslynn
Posted by Jay2112 on September 19, 2022, at 20:17:12
In reply to Re: remission )) » Jay2112, posted by Roslynn on September 19, 2022, at 14:49:04
> >Amphetamine with carbamazepine has worked unbelievably for me, when I was at my absolute worse. I just thought since Ritalin worked for you, this combo might work.
> >
> > Jay
> >
> Jay, is your diagnosis unipolar or bipolar 1 or 2?
>
> Thank you,
> Roslynn
>
>It's Bipolar 2, but my pdoc says it works for any bipolar. Reason being is he is not sure of to put me in bipolar 1 or 2. He thinks it may be a combination, because he has seen this in many other patients. I'd say if Ritalin works for you, try it with carbamazepine. I was 3 weeks in the hospital and it rocketed me out of suicidal depression, with much less hypomania than without carbamazepine.
Best,
Jay
Posted by undopaminergic on September 20, 2022, at 6:32:21
In reply to Re: remission ))SLS » undopaminergic, posted by Jay2112 on September 19, 2022, at 12:18:28
> >
> > > I've also seen evidence for methylphenidate as successful monotherapy in depression
> > >
> >
> > It did work for me, substantially or even better. It relieved my apathy and my depressive thinking (including suicidal ideation). It was still only a partial response, however -- I did not achieve remission.
> >
> > The only remission I've experienced since the onset of depression in the end of 1999, is the remission that was part of my first (hypo)manic episode.
> >
> > -undopaminergic
> >
>
> Do the mood stabilizers not work for you?I've not evaluated them sufficiently to know. I've used lamotrigine a lot, but not at higher doses (beyond 200 mg), and I've tried lithium only briefly. I haven't tried other mood stabilisers at all, unless you consider antipsychotics.
> Have you tried combining Ritalin with carbamazepine? Amphetamine with carbamazepine has worked unbelievably for me, when I was at my absolute worse. I just thought since Ritalin worked for you, this combo might work.
>Probably, but so far I've had problems getting a prescription for amphetamines.
-undopaminergic
Posted by SLS on September 20, 2022, at 7:16:29
In reply to Re: remission )) » Roslynn, posted by Jay2112 on September 19, 2022, at 20:17:12
Hi, Jay.
> > >Amphetamine with carbamazepine has worked unbelievably for me, when I was at my absolute worse. I just thought since Ritalin worked for you, this combo might work.
> > >
> > > Jay
> > >
> > Jay, is your diagnosis unipolar or bipolar 1 or 2?
> >
> > Thank you,
> > Roslynn
> >
> >
>
> It's Bipolar 2, but my pdoc says it works for any bipolar. Reason being is he is not sure of to put me in bipolar 1 or 2. He thinks it may be a combination, because he has seen this in many other patients. I'd say if Ritalin works for you, try it with carbamazepine. I was 3 weeks in the hospital and it rocketed me out of suicidal depression, with much less hypomania than without carbamazepine.
>
> Best,
> JayDo you think oxcarbazepine (Trileptal) would make for a substitute for carbamazepine (Tegretol)?
The two drugs are chemically related. Oxcarbazepine seems to be as potent as carbamazepine in the majority of studies comparing their efficacies in seizure disorders However, oxcarbazepine lacks the side effect of suppressing the immune system in the form of agranulocytosis (stopping the formation of granulocyte white blood cells). Although carbamazepine has this as a possible adverse reaction, it is a rather rare occurrence. Still, periodic blood tests are necessary to assay the number of granulocytes. Agranulocytosis can be fatal.
There is another advantage to oxcarbazepine. It doesn't cause the same sort of sedation and foggy-brain that many people experience with carbamazepine. Not everyone experiences this side-effect, of course. The one caution when taking oxcarbazepine is that it sometimes produces hyponatremia (low blood sodium). This can also be monitored with blood tests at the beginning of treatment. Symptoms of hyponatremia include headache, general malaise, gait disturbance, and somnolence. Often, there are no symptoms at all. I was surprised to learn that as many as 25% of people taking oxcarbazepine develop some degree of hyponatremia. It should be noted that carbamazepine can cause hyponatremia, too, but with a substantially lower frequency.
I felt an enormous difference between the two drugs with respect to sedation and brain-fog. If anything, I found oxcarbazepine to be somewhat stimulating.
There are reasons why someone would want to choose one drug over the other.
- Scott
Posted by Roslynn on September 20, 2022, at 14:50:39
In reply to Re: remission )) » Roslynn, posted by Jay2112 on September 19, 2022, at 20:17:12
Posted by Jay2112 on September 21, 2022, at 21:00:28
In reply to Re: remission ))SLS » Jay2112, posted by undopaminergic on September 20, 2022, at 6:32:21
> > >
> > > > I've also seen evidence for methylphenidate as successful monotherapy in depression
> > > >
> > >
> > > It did work for me, substantially or even better. It relieved my apathy and my depressive thinking (including suicidal ideation). It was still only a partial response, however -- I did not achieve remission.
> > >
> > > The only remission I've experienced since the onset of depression in the end of 1999, is the remission that was part of my first (hypo)manic episode.
> > >
> > > -undopaminergic
> > >
> >
> > Do the mood stabilizers not work for you?
>
> I've not evaluated them sufficiently to know. I've used lamotrigine a lot, but not at higher doses (beyond 200 mg), and I've tried lithium only briefly. I haven't tried other mood stabilisers at all, unless you consider antipsychotics.See, I found lithium to have lots, I mean LOTS, of hit and miss. Not to take away from other's experiences, but lithium works good, (with all other meds Ritalin ) sometimes...and then sometimes I feel so psyched-out...freaked out, almost psychotic, on it. I have tried every dose..all different conditions. BUT, it works for some, and may work for you.
Carbamazepine, for me, puts a nice blanket on anxiety, and works great with stimulants. I was suggesting, not amphetamine, but if you can try
Ritalin with it? I find it seems to act a bit like a sedating antipsychotic, and shuts the weird 'chatter' in my head down, fast. It oddly can have both mild stimulating and sedating properties. You just really have to try it yourself.
> > Have you tried combining Ritalin with carbamazepine? Amphetamine with carbamazepine has worked unbelievably for me, when I was at my absolute worse. I just thought since Ritalin worked for you, this combo might work.
> >
>
> Probably, but so far I've had problems getting a prescription for amphetamines.Again, I was suggesting with Ritalin, if you can get it.
> -undopaminergic
>Best,
Jay
Posted by Jay2112 on September 21, 2022, at 21:16:32
In reply to Re: remission )), posted by SLS on September 20, 2022, at 7:16:29
Hey Scott!
> Hi, Jay.
>
> > > >Amphetamine with carbamazepine has worked unbelievably for me, when I was at my absolute worse. I just thought since Ritalin worked for you, this combo might work.
> > > >
> > > > Jay
> > > >
> > > Jay, is your diagnosis unipolar or bipolar 1 or 2?
> > >
> > > Thank you,
> > > Roslynn
> > >
> > >
> >
> > It's Bipolar 2, but my pdoc says it works for any bipolar. Reason being is he is not sure of to put me in bipolar 1 or 2. He thinks it may be a combination, because he has seen this in many other patients. I'd say if Ritalin works for you, try it with carbamazepine. I was 3 weeks in the hospital and it rocketed me out of suicidal depression, with much less hypomania than without carbamazepine.
> >
> > Best,
> > Jay
>
> Do you think oxcarbazepine (Trileptal) would make for a substitute for carbamazepine (Tegretol)?Yeah, I've tried oxcarbazepine, and it doesn't, for me, have the 'relaxing' feeling carbamazepine does. I've read this quite a bit among users who have tried both. I think it's the carbamazepine's anticholinergic action, and I think it might act a bit stronger on potassium channels. But, more the former than the latter. That may not be advantageous for some, who might get the 'brain fog' you talk about. But, I think my illness may be partly based on a hyperactive cholinergic system.
> The two drugs are chemically related. Oxcarbazepine seems to be as potent as carbamazepine in the majority of studies comparing their efficacies in seizure disorders However, oxcarbazepine lacks the side effect of suppressing the immune system in the form of agranulocytosis (stopping the formation of granulocyte white blood cells). Although carbamazepine has this as a possible adverse reaction, it is a rather rare occurrence. Still, periodic blood tests are necessary to assay the number of granulocytes. Agranulocytosis can be fatal.
I get tested once in awhile, but (knock on wood) hasn't been a problem.
> There is another advantage to oxcarbazepine. It doesn't cause the same sort of sedation and foggy-brain that many people experience with carbamazepine. Not everyone experiences this side-effect, of course. The one caution when taking oxcarbazepine is that it sometimes produces hyponatremia (low blood sodium). This can also be monitored with blood tests at the beginning of treatment. Symptoms of hyponatremia include headache, general malaise, gait disturbance, and somnolence. Often, there are no symptoms at all. I was surprised to learn that as many as 25% of people taking oxcarbazepine develop some degree of hyponatremia. It should be noted that carbamazepine can cause hyponatremia, too, but with a substantially lower frequency.
>
> I felt an enormous difference between the two drugs with respect to sedation and brain-fog. If anything, I found oxcarbazepine to be somewhat stimulating.Again, that anti-stim feeling seems to work for me. The dichotomy, with a stim and anti-stim..well...Yeah, I AM weird..lol.
> There are reasons why someone would want to choose one drug over the other.
>
>
> - Scott
>Yes, true, and I guess it boils down to "Some like it hot.."..lol. Well, not quite....but you get what I mean..
Hope you are doing well,
Jay :)
Posted by Jay2112 on September 21, 2022, at 21:25:04
In reply to Re: remission )) Thank you Jay! (nm) » Jay2112, posted by Roslynn on September 20, 2022, at 14:50:39
Thank you Roslynn!! I really, really wish you best in trying to find that elusive mix! Can you list the meds you are on? Maybe others have some ideas too. The one main *rule* I have found with being bipolar, is to keep the antidepressant level as absolutely low as possible. Too high, and I found I REALLY struggle. Really low, and moods are a bit more even.If you are taking Ritalin, I might suggest a one or two day break a week. For me, that keeps it potent when you do use it.
Just thinking out loud..lol. You got this!! Keep going :)
Best,
Jay
Posted by undopaminergic on September 22, 2022, at 7:31:43
In reply to Re: remission ))SLS, posted by Jay2112 on September 21, 2022, at 21:00:28
>
> Carbamazepine, for me, puts a nice blanket on anxiety, and works great with stimulants. I was suggesting, not amphetamine, but if you can try
> Ritalin with it? I find it seems to act a bit like a sedating antipsychotic, and shuts the weird 'chatter' in my head down, fast.
>That sounds interesting. This chatter, does it refer to your inner "voice", your thinking?
I have something I call the "silent buzz". I can't actually hear it, not even as an inner voice, but it's there and I notice when it's gone. When it's gone, there is only a conspicuous silence as well as what I'm experiencing through my senses. When it's gone, I can pay attention. I only remember it ever having been gone briefly, and that was in response to my first doses of phenylethylamine (PEA; an amphetamine-like trace amine) with selegiline.
> It oddly can have both mild stimulating and sedating properties. You just really have to try it yourself.
>I'm interested, so it's something to revisit later.
> > Probably, but so far I've had problems getting a prescription for amphetamines.
>
> Again, I was suggesting with Ritalin, if you can get it.I used to get Concerta, but right now, I can hardly get anything at all!
-undopaminergic
Posted by SLS on September 22, 2022, at 7:54:15
In reply to Re: remission )) » SLS, posted by Jay2112 on September 21, 2022, at 21:16:32
Hi, Jay.
> Hope you are doing well,
> Jay :)I am still very much improved. You are kind to ask.
I had to raise my dosage of nortriptyline from 100 mg/day to 150 mg/day. It should make a big difference. It already is. 100% remission is keeping my eyes on the prize.Nardil 90 mg/day
Nortriptyline 150 mg/day
Lamictal 300 mg/day
Lithium 300 mg/day
- Scott
Posted by Roslynn on September 22, 2022, at 9:38:50
In reply to Re: remission )) Thank you Jay! » Roslynn, posted by Jay2112 on September 21, 2022, at 21:25:04
Hi Jay,
My meds are: Effexor xr 150; Latuda 60mg; Ativan three times per day (I'm on a high dose); Seroquel 300 mg; Ritalin 5mg; vitamin D supplement; and meds for asthma and high blood pressure.
Thank you for any thoughts.
Roslynn
Posted by Jay2112 on September 22, 2022, at 10:03:14
In reply to Re: remission )) Thank you Jay! » Jay2112, posted by Roslynn on September 22, 2022, at 9:38:50
> Hi Jay,
>
> My meds are: Effexor xr 150; Latuda 60mg; Ativan three times per day (I'm on a high dose); Seroquel 300 mg; Ritalin 5mg; vitamin D supplement; and meds for asthma and high blood pressure.
>
> Thank you for any thoughts.
>
> RoslynnHi Roslynn:
No prob at all!! Is anxiety still your main challenge? I was on Latuda, and found the same. There is also another med for the anxiety Latuda causes..actually a few of them:
-Remeron (mirtazipine) 15 mg at bedtime (very good for sleep and anxiety)
=Cogentin (Benztropine) various doses 2x daily
-Inderal (Propanolol) 10-20mgs 2 x daily (excellent..most popular..works well with Remeron)Can you ask your doctor about these? You can google akathisia, a anxiety provoking side effect of Latuda, and Seroquel, or any antipsychotic, to find out more. You should find those meds I mentioned above to remedy it.
Jay
Posted by Roslynn on September 22, 2022, at 14:41:47
In reply to Re: remission )) Thank you Jay! » Roslynn, posted by Jay2112 on September 22, 2022, at 10:03:14
> Hi Roslynn:
>
> No prob at all!! Is anxiety still your main challenge?
Hi Jay,It's both anxiety and severe depression.
>I was on Latuda, and found the same. There is also another med for the anxiety Latuda causes..actually a few of them:
>
> -Remeron (mirtazipine) 15 mg at bedtime (very good for sleep and anxiety)
> =Cogentin (Benztropine) various doses 2x daily
> -Inderal (Propanolol) 10-20mgs 2 x daily (excellent..most popular..works well with Remeron)
>
> Can you ask your doctor about these? You can google akathisia, a anxiety provoking side effect of Latuda, and Seroquel, or any antipsychotic, to find out more. You should find those meds I mentioned above to remedy it.
>
> Jay
I gained a lot of weight on Remeron unfortunately. Beta blockers make me feel really down especially combined with the Seroquel, I think. I can ask my Dr. about the Cogentin.Thank you for your suggestions!
Roslynn
>
>
>
Posted by SLS on September 22, 2022, at 18:25:31
In reply to Re: remission )) Thank you Jay!, posted by Roslynn on September 22, 2022, at 14:41:47
Hi, Roselynn.
A few more thoughts.
1. Abilify: The anxiety you reported while taking Abilify might have been akathisia. Akathisia is dosage-dependent and can be triggered by overly aggressive dosing at the beginning of treatment. The dosage of Abilify optimal for treating depression is usually very low: 2-5 mg/day.
What dosage of Abilify were you started at?
What dosage of Abilify did you arrive at?
At what dosage of Abilify did the anxiety / akathisia emerge?
How long did you take Abilify for?
Did you feel any improvement in depression at all?
2. Have you taken any of the following tricyclic antidepressants?
- imipramine (Tofranil)
- desipramine (Norpramin)
- amitriptyline (Elavil)
- nortryptyline (Pamelor)
- clomipramine (Anafranil)3. If your depression has a bipolar diathesis (like mine), perhaps you need to take a combination of MAOI + TCA (like I do). Maybe? It might be worth a try if you can get a doctor to research the efficacy and safety of this treatment.
Allowed MAOIs: Nardil, Parnate, Marplan.
Allowed TCAs: Desipramine, Nortryptyline
Probably safe TCAs: Amitriptyline, Doxepin, Trimipramine.
Dangerous TCAs: Imipramine, Clomipramine
In general, MAOIs cannot be combined with any drug that has as one of its properties the inhibition of the reuptake of serotonin. This is probably true drugs that increase serotonin release as well.
SSRIs (Prozac, Zoloft, Paxil, Celexa, Lexapro)
SNRIs (Effexor, Pristiq, Cymbalta, milnacipran, levomilnacipran)
Other contraindicated serotonergic drugs include fenfluramine, dexfenfluramine, tramadol, sibutramine, dextromethorphan, phenylpiperidine, methadone, levorphanol, and several opioids.
Between the no-tyramine diet and the drug contraindications, it looks pretty scary at first look. However, avoiding foods containing tyramine and drugs that are pro-serotonergic has not been terribly inconvenient.
- Scott
Posted by Roslynn on September 22, 2022, at 19:23:57
In reply to Re: remission )) Thank you Jay! » Roslynn, posted by SLS on September 22, 2022, at 18:25:31
Hi Scott,
Thanks for your note.
On Abilify 2.5 mg, I became very irritable and wanted to spend more than usual. I stopped that med pretty quickly.
> Did you feel any improvement in depression at all?
>
I don't think it made me feel any better.
> 2. Have you taken any of the following tricyclic antidepressants?
> - imipramine (Tofranil)
> - desipramine (Norpramin)
> - amitriptyline (Elavil)
> - nortryptyline (Pamelor)
> - clomipramine (Anafranil)I have taken desipramine many years ago,plus Pamelor which made me very dizzy and Anafranil which didn't do anything even at a high dose.
> 3. If your depression has a bipolar diathesis (like mine), perhaps you need to take a combination of MAOI + TCA
I have had trials of both nardil (intolerable dizziness) and parnate (dangerous spikes in blood pressure unrelated to anything i had eaten, drank, taken, etc.)
As always, thank you for your thoughts.
Roslynn
> - Scott
Posted by Jay2112 on September 22, 2022, at 21:08:49
In reply to Re: remission )) » Jay2112, posted by SLS on September 22, 2022, at 7:54:15
Greets Scott!
> Hi, Jay.
>
> > Hope you are doing well,
> > Jay :)
>
> I am still very much improved. You are kind to ask.
>
> I had to raise my dosage of nortriptyline from 100 mg/day to 150 mg/day. It should make a big difference. It already is. 100% remission is keeping my eyes on the prize.
>
> Nardil 90 mg/day
> Nortriptyline 150 mg/day
> Lamictal 300 mg/day
> Lithium 300 mg/day
>
>
> - ScottI am very glad you are doing well, as I know how long it took you to find your 'mix'. Each of us...genetic blends...with uncertain ends...that's a song, I think..lol. I have found nortriptyline to be both energizing (likely it's norepinephrine effect) and sedating (anticholinergic effects). But, glad it is working!
I have come down on Effexor, from 150 to 75mg's, and after 3 weeks, I don't know why the heck I didn't do it sooner! But, I have added 10mg of Trintellix, and wow, after a month, with these 2 changes, I have become the more relaxed guy I *thought* I was...but the damn Effexor, at higher doses, was way, way too stimulating!! Trintellix apparently has some type of small effect on the cholinergic system, and I don't think it is anticholinergic. Maybe, a small bump up of choline transmission, with all my anticholinergics, is a good thing! We will see.
But, honestly, I haven't felt this good in years! (And it is far from hypomania....little ups and downs each day...but a feeling like..'Ya...I can handle it!!')
Best,
Jay :)P.s. I wish there was a (genuine) political party called "Let's All Be/Get Happy". Not 'toxic' phony happy...but just...let happy be a TRUE right. Let each person become a kid again! Ok, I am really going on here..lol. ADD and Asperger's....uhhyyeee..
Posted by Jay2112 on September 22, 2022, at 21:26:23
In reply to Re: remission )) Thank you Jay!, posted by Roslynn on September 22, 2022, at 14:41:47
>
>
> > Hi Roslynn:
> >
> > No prob at all!! Is anxiety still your main challenge?
>
>
> Hi Jay,
>
> It's both anxiety and severe depression.
>
>
> >I was on Latuda, and found the same. There is also another med for the anxiety Latuda causes..actually a few of them:
> >
> > -Remeron (mirtazipine) 15 mg at bedtime (very good for sleep and anxiety)
> > =Cogentin (Benztropine) various doses 2x daily
> > -Inderal (Propanolol) 10-20mgs 2 x daily (excellent..most popular..works well with Remeron)
> >
> Jay
>
>
> I gained a lot of weight on Remeron unfortunately. Beta blockers make me feel really down especially combined with the Seroquel, I think. I can ask my Dr. about the Cogentin.Yes, those dang side effects! I think Cogentin might be worth a shot. But, again, I hope you can have a shot at Tegretol (carbamazapine) first, as it is used in unipolar and bipolar 1 and 2. Do you take Seroquel XR? Or the regular release? Because, Seroquel regular worked good for a bit, but it also seemed to make me both super anxious and depressed. But a smaller dose of XR was a nice, smooth sail through the day.
Have you ever tried amphetamine (Adderal, Dexedrine, Vyvanse)?
It WILL get better...I know you don't think that now...but it does. Hope..hope...hope...
Jay
> Thank you for your suggestions!
>
>
> Roslynn
> >
> >
> >
>
>
Posted by Jay2112 on September 22, 2022, at 21:31:59
In reply to Re: remission )) Thank you Jay! » SLS, posted by Roslynn on September 22, 2022, at 19:23:57
Just off the top of my head...Vraylar is getting top reviews in social media for BP 1 + 2. Do you have affordable access to it?
Jay
Posted by SLS on September 22, 2022, at 21:39:38
In reply to Re: remission )) Thank you Jay! » SLS, posted by Roslynn on September 22, 2022, at 19:23:57
> Hi Scott,
>
> Thanks for your note.
>
> On Abilify 2.5 mg, I became very irritable and wanted to spend more than usual. I stopped that med pretty quickly.
>
> > Did you feel any improvement in depression at all?
> >
> I don't think it made me feel any better.
I don't think akathisia as a side effect of Abilify disappears on its own very often. You did the right thing.As far as Nardil is concerned, it always made me very dizzy and gave me problems with micturition (initiating urination). I must have tried Nardil ten times or so in 40 years. Without fail, the dizziness emerged and remained problematic. This time, I decided to play a hunch. I thought that if I didn't trigger these side effects in the first place, I might prevent them from emerging at all. I started at 7.5 mg/day (1/2 pill) for a week before going to 15 mg/day. I think I increased the dosage every two weeks by 15 mg/day. At 60 mg/day, you should wait at least three weeks before increasing the dosage again. If 60 mg/day is the right dosage for you, it should show some hint of positive effect by the end of the third week. My guess is that most people respond to Nardil at a dosage of 75 mg/day. I need 90 mg/day. If you tolerate 75 mg/day, you should think about remaining at that dosage for a minimum of 4-6 weeks. If, after 6 weeks, you are tolerating Nardil with respect to side effects, it makes no sense not to go to 90 mg/day.
From what I've learned over the years, the therapeutic dosage ranges are:
1. Nardil - 60-90 mg/day
2. Parnate - 40-80 mg/day
3. Marplan - 40-60 mg/day (I have less experience with this drug).* For special cases, using "high-dosage" treatment with Parnate can go up to 120-150 mg/day.
I understand that you have problems with blood-pressure spikes with Parnate. With Nardil, if you cannot tolerate a minimum of 60 mg/day for three weeks and no sign of abatement of side effects, the best recourse is probably to discontinue it. Nardil is one of the drugs that I consider crucial to give a long trial if there is any bipolar contribution to your depression.
Regarding Caplyta (lumateperone), drug manufacturers usually have programs to provide expensive drugs to people who are limited financially. I haven't seen anything magical about Latuda for bipolar depression. I'm not really sure that it has a place in treating unipolar depression.
>Anafranil (clomipramine) is probably the tricyclic that gets the most people well. However, there are people who don't respond to high dosages of Anafranil who respond well to nortriptyline. Regarding nortriptyline, there is a true dosage window. For example:
75 mg/day = no response
150 mg/day = 100% remission
200 mg/day = relapseMeasuring blood levels of nortriptyline can help act as a guide. The accepted therapeutic range is 50-150 ng/ml. From what I've observed, either one is a low-dosage responder (75 mg/day) or a high-dosage responder (150 mg/day). Not many people respond well to 100 mg/day.
- Scott
Posted by SLS on September 23, 2022, at 8:14:05
In reply to Re: remission )) » SLS, posted by Jay2112 on September 22, 2022, at 21:08:49
> Greets Scott!
>
> > Hi, Jay.
> >
> > > Hope you are doing well,
> > > Jay :)
> >
> > I am still very much improved. You are kind to ask.
> >
> > I had to raise my dosage of nortriptyline from 100 mg/day to 150 mg/day. It should make a big difference. It already is. 100% remission is keeping my eyes on the prize.
> >
> > Nardil 90 mg/day
> > Nortriptyline 150 mg/day
> > Lamictal 300 mg/day
> > Lithium 300 mg/day
> >
> >
> > - Scott
>
> I am very glad you are doing well, as I know how long it took you to find your 'mix'. Each of us...genetic blends...with uncertain ends...that's a song, I think..lol. I have found nortriptyline to be both energizing (likely it's norepinephrine effect) and sedating (anticholinergic effects). But, glad it is working!
>
> I have come down on Effexor, from 150 to 75mg's, and after 3 weeks, I don't know why the heck I didn't do it sooner! But, I have added 10mg of Trintellix, and wow, after a month, with these 2 changes, I have become the more relaxed guy I *thought* I was...but the damn Effexor, at higher doses, was way, way too stimulating!! Trintellix apparently has some type of small effect on the cholinergic system, and I don't think it is anticholinergic. Maybe, a small bump up of choline transmission, with all my anticholinergics, is a good thing! We will see.That is so rewarding to read. I hope you continue move forward with your recovery (biological, psychological, occupational, and vocational).
Trintellix is an unusual antidepressant. It binds to a surprising number of different receptor subtypes. This includes the blocking of the serotonin 5-HT7 receptor, one that has been the target of much study recently in the treatment of depression.
- Scott
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