Posted by JohnL on April 18, 2000, at 2:11:17
In reply to Re: John!, posted by elise on April 17, 2000, at 8:39:52
Elise,
Your responses so far to Adderall, Prozac, Celexa, or Provigil do give some clues.
First, there may be a low serotonin component. But only slightly low. I say that because Prozac is somewhat helpful. But higher doses turn negative. That indicates a low dose may be the optimum way to go for this chemistry. The non response to Celexa kind of puts the whole low serotonin theory in question. But the partial response to Prozac is worth noting and may be an important clue. It's just that a small dose might be best. Negative responses to higher doses prove this.
The negative responses to everything else point to norepinephrine and/or dopamine malfunction...but not due to low levels of these neurotransmitters. If anything, they might actually be elevated. In your shoes I would consider one of two strategies.
My first priority would be to explore the atypical antipsychotics. They have a wide range of therapeutic action, and are very useful for many symptoms besides schizophrenia...even in the total absence of any schizo symptoms. Top three choices would be: Zyprexa (sedating at first, take at dinnertime, often causes weight gain. Dose to try would be in the 2.5mg to 7.5mg range); Risperdal (less sedating, less weight gain, dose 2mg to 4mg); Stelazine (least sedating, actually somewhat alerting, the closest thing to Amisulpride available). In a perfect world with a cooperative physician, it would be nice to compare these to find which is the best match for your chemistry. That would mean trying each for about two weeks with a day or two washout inbetween. Then go with the best for a longer trial. In a not so perfect world with a resistant physician, I would go with Zyprexa because it overall has the strongest track record and is becoming rather popular for a variety of psychiatric conditions, including depression. Improvement is very often noted rather quickly, like from day 2 to day 7.
Another strategy would be to explore the anticonvulsants, especially the ones noted for antidepressant qualities and minimal side effects. Top choice in that category meeting those criteria would be Lamictal. Its only serious side effect is a dangerour rash which is almost always a result of increasing dose too fast. Must increase by 25mg a week. Target range is 100mg to 400mg.
In your shoes I would be looking at Zyprexa and its cousins first, and Lamictal second. I would for the time being steer away from other SSRIs and tricyclics in your case. If both the antipsychotics and anticonvulsants disappoint, then we can always come back and explore the other more common antidpressants not yet tried. But negative results to them so far justifies--in my nonprofessional opinion only--exploring different drug classes. I'm no doctor, and I'm not pretending to play one, I'm just telling you what I personally would do if I were in your shoes, and why. I hope it helps. :-) JohnL
poster:JohnL
thread:30297
URL: http://www.dr-bob.org/babble/20000411/msgs/30433.html