Posted by JohnL on October 30, 2001, at 18:35:57
In reply to What meds now???I am still depressed, posted by Dona on October 30, 2001, at 14:23:49
> I am on 80mg prozac, 30mg remeron and 5 mg zyprexa and I was hit with major depressive feelings again over this past weekend. Why I don't know. I just know I do not want to be in this body anymore. I see my doc tomorrow. The remeron really does help me sleep. Does anyone think that effexorxr would be better than prozac and should I just stop the zyprexa? The zyprexa was supposed to augment the prozac but it sure has not worked. And how do you get out of this terrible cloudy hole?????
Hi Dona,
I'm sorry to hear things are rough right now. It sounds like you are strong willed and hanging in there, which indicates to me you are going to get better.There are a lot of possibilities. Here are some that came to mind:
1) Drop Prozac down to 40mg, start Effexor low dose, and eventually ween off the Prozac while titrating up on Effexor. Or, as a couple people here discovered by accident, the combination of Prozac and Effexor can work better than either alone.
2) Drop Prozac down to 40mg, start Desipramine 12.5mg for a few days, then up to 25mg, and then increase as tolerated. At Depression Central I noticed a popular psychiatrist there has good luck adding Desipramine to Prozac when high dose Prozac alone didn't work. There is also clinical evidence showing how well the two drugs go together. Since Prozac slows down the metabolism of Desipramine, the blood level of Desipramine is automatically increased anywhere from 2 to 5 times. That means you only need small doses to get a lot.
3) In that same vein, Nortriptyline. Years ago there was one clinical study where a positive response to Ritalin predicted a positive response to Desipramine. A negative or neutral reaction to Ritalin predicted a better response with Nortriptyline. I did this test on myself, my own n=1 study, and it proved accurate. I loved Ritalin, too much. But when that pointed to Desipramine, I was shocked when it worked in 3 hours. What's this 6 week wait stuff? I think when meds don't work, it just means they are off target from whatever the real underlying chemical problem exists. When they are on target, dramatic results can occur rapidly.
4) For immediate relief, you could try Ritalin and/or Adderall. These psychostimulants are usually for ADHD or ADD, but are usually helpful in augmenting antidepressants. They work in hours to days, instead of weeks or months.
5) Try Lithium at 300mg for a few days and then increase to 600 and maybe 900. Low dose augmentation of SSRIs is probably the most popular strategy among clinicians.
6) Another mood stabilizer worth looking at is Lamictal.
7) A novel approach that sometimes works miracles is to add Naltrexone 50mg to 100mg to Prozac. This has been known to get a better response, avoid or fix SSRI poopout, and could be one of the drugs on your radar screen.
8) Wellbutrin. This one would hit some chemistries that are so far being missed by your current drugs.Anyway, just some ideas. Which do I like the best? I'm undecided. I'm torn between two....the Ritalin test or Wellbutrin. I'm kind of steering in this direction because I was trying to focus on what might hold the highest probability of getting you feeling better as fast as possible. But in all reality, any of the above suggestions could end up working nicely. No matter what you do, you will probably be able to lower the Prozac dose.
Hope this is helpful.
John
poster:JohnL
thread:82672
URL: http://www.dr-bob.org/babble/20011025/msgs/82691.html