Posted by SLS on April 27, 2005, at 8:26:02
In reply to Re: Keppra » SLS, posted by theo on April 26, 2005, at 23:12:43
> >
> > That sounds like a bona-fide biological depression to me. Loss of interest, motivation, and reward. You are right in thinking that it would be more productive to engage in CBT without the depression getting in the way. Therefore, it is logical to attack the depression first. If you hit the bullseye, you can move forward. However, if you don't hit the bullseye, you might benefit from trying to move forward with the CBT anyway. Progress would be slow, but it would still help to chip away at your fears and inhibitions.
> >
> > How did you respond to Parnate?
> >
> >
> > - Scott
>
> Actually, I've never tried Parnate, Nardil or any TCA's, only SSRI's and anticonvulsants. So now's the big question, what to try. Not only what class but then which med within that class?Don't forget about Effexor or Cymbalta. Either of these are worth a try if you haven't tried them already.
From the land of TCA comes desipramine and nortriptyline. Both of these drugs have mild side effects compared to the others. I would give a small advantage to nortriptyline. However, one must be diligent in establishing blood levels in the beginning such that the dosage chosen results in values between 50-150 ng/ml. There are people, however, whom respond to desipramine and not to nortriptyline.
desipramine 150-300mg
nortriptyline 50-100mgFor MAOIs, it is difficult to choose whether to go with Parnate or Nardil. If lack of energy is not a problem, and there exists anxiety disorders or OCD, Nardil might be the best choice. However, there are some people who respond to Parnate who don't respond to Nardil, so you can't discount all MAO inhibitors based upon your non-response to only one of them.
Parnate 40-80mg
Nardil 60-90mgTheo, it seems to me that there are still quite a few avenues of treatment you have not explored yet. The odds are in your favor that you will find something that works well.
- Scott
poster:SLS
thread:487624
URL: http://www.dr-bob.org/babble/20050423/msgs/490262.html