Posted by SLS on August 18, 2001, at 8:50:10
In reply to Re: PARNATE, has anyone who had a horrible start » SLS, posted by shelliR on August 15, 2001, at 14:52:15
> YOU'RE BACK. How are you? Why away for so long? Did you move? Meds any better?
Hi ShelliR.
Well, I wouldn't exactly say that I'm back. Things have pretty much sucked for the last few months. I haven't been feeling well enough to post. Fortunately, things didn't deteriorate until after I moved into my new apartment. I've been here for over two months and still have a bunch of stuff to unpack. I'm real happy with the place, though.
A few months ago, I added Effexor to the Lamictal 300mg and nortriptyline 100mg that I had been taking. At first, I experienced some encouraging hints of improvement at 150mg/day. However, I quickly deteriorated and became as severely depressed as I have been in a long time. Basically motionless. I thought perhaps that the Effexor was reducing the clearance of nortriptyline (CYP450 2D6 ?) and thereby raising blood-levels beyond my therapeutic window. Whatever - lowering the dosage of nortriptyline helped. However, my doctor was reluctant to prescribe more than 25mg/day. After trying a dosage of Effexor of 450mg for a month, I have reduced it down to 300mg. My doctor feels that this is the minimum dosage at which the full range of its benefits can be adequately tested. I am now in the process of increasing the dosage of nortriptyline to see what I can squeeze out of it. My main complaints regarding Effexor are that it has generally reduced drive, motivation, and libido. It seems to have also produced a bit of "brain fog", and has left me feeling pretty stupid - more stupid than usual.
I am trying to fight the temptation to switch over to Nardil immediately. Logically, I guess it makes sense to continue playing with augmentation strategies. I should at least finish exploring the optimization of nortriptyline dosing. Nortriptyline is truly a pain in the ass for me. It really does have a finicky window. I sometimes feel like I should just dump it and gorge myself on imipramine, a drug that seems to help me as much as nortriptyline, but is without a window. The only thing is that the anticholinergic side effects of imipramine make it more difficult to add Nardil to. Hypotension , constipation, and urinary retention are of most concern. Imipramine also produces more cognitive side effects (memory difficulties and dull-wittedness) and weight-gain. If it were to work, though, the restoration of the cognition stolen by depression would more than offset any negative effects produced by the drug. We'll see. I'll probably at least try adding Geodon or Zyprexa to Effexor before making the switch.
I understand that you are interested in trying Nardil again. I would like to mention that, for me, the addition of desipramine to Nardil not only produced a better antidepressant effect, but also seemed to prevent the weight-gain that I had previously experienced with Nardil.
Thanks for your kind concern.
- Scott
poster:SLS
thread:75079
URL: http://www.dr-bob.org/babble/20010814/msgs/75482.html