Posted by Mark H. on January 30, 2002, at 1:13:19
In reply to BEST Med Combo! (IsoM, Rick, Ray, OldSchool), posted by spike4848 on January 26, 2002, at 11:20:16
As is often the case, I agree with IsoM. I think it is risky to generalize, but yes, there is validity in your observation that a number of us have had success with a combination that includes at least some of the medications you've mentioned.
It took me four years and trials with more than 25 different anti-depressants and adjunctives before hitting on the right combination for me. If my experience can help cut short your search, then that is wonderful. However, each person is unique.
This is my working cocktail:
Effexor (not an SSRI, but let's not get into that), 150 mg a day with breakfast. NOT sustained-release -- I WANT it to wear off some by bedtime to avoid aching legs and restlessness.
A stimulant: methylphenidate, 20 to 40 mg a day, on awaking in the morning. Again, I want it to wear off by the end of the day. Two powerful benefits: not falling asleep at my desk at 2pm AND it potentiates Effexor so that I don't have to take ever-increasing dosages.
Alternative experience: I tried Provigil for four months, felt great, but didn't get a damned thing done! Looking back, I can't believe how much I procrastinated and how little I cared about the potential of losing my job. Not good! REALLY not good! And DINGBAT, check the price for Provigil before you get any romantic ideas. :-)
Alternative experience #2: Dexedrine. Experimenting with it currently as a way to take a break from Ritalin and still stay awake during the day. My intial impressions are that it is a little too much like caffeine (which I quit completely 14 years ago) and adrenaline for my body.
Pindolol: a beta-blocker. It used to be a medical supposition that the over-production of adrenaline was associated with depression. That theory has since fallen out of favor, except with those of us whose bodies chronically produce too much adrenaline -- we're pretty sure it has *something* to do with our depression, whether doctors understand it yet or not. :-) Lots of down-sides to taking beta-blockers, but two amazing pluses: it too potentiates Effexor (makes its effect stronger, allowing me to take a smaller dose than I otherwise would, and with improved anti-depressant effect), and it helps insure a great night's sleep by blocking the effects of adrenaline. I should also mention that taking a small dosage of a beta blocker morning and evening has also kept me from going into my annual adrenaline addiction-exhaustion cycle, which used to occur every August.
And yes, clonazepam! I take it primarily because I have Periodic Limb Movement Disorder and a REM defect, which is fancy talk for saying I kick my poor wife while I'm dreaming and keep her awake with jerky, rhythmic movements if I DON'T take it.
It also is the safest and least habit-forming of the benzodiazepines. In my opinion, it should be over-the-counter in 0.25mg doses. It too contributes to a great night's sleep, which helps with my depression and periodic hypomania. At 0.5 mg, I can't get up in the morning, however, so I have a built-in incentive to keep my dosage as low as possible.
To a "normal" person, my regimen may sound like I take stimulants to wake up, an anti-depressant to make it through the day, and a mild tranquilizer and a beta-blocker to sleep at night. On one level, I suppose that's true.
However, this mix of meds, followed by two years of intensive therapy once meds put a working floor under me, enabled me to get out of four years of severe depression and maintain a responsible job, which benefits everybody.
That my regimen bears some similarity to others' is perhaps no coincidence. At the same time, I cannot caution you enough about how carefully I have balanced and worked with my doctor on fine-tuning my meds. A tiny bit more beta-blocker than I need, and I get cardiac disrhythmias and nearly pass out from moderate exercise, for instance.
Good luck in your quest, and please let us know what winds up working for you!
Best wishes,
Mark H.
poster:Mark H.
thread:91674
URL: http://www.dr-bob.org/babble/20020124/msgs/92130.html