Posted by SLS on October 14, 2005, at 16:05:41
In reply to Re: Need something to hope for., posted by denise1966 on October 14, 2005, at 14:11:50
Hi Denise.
I'm currently visiting a friend in Minnesota, so I really don't know what's going on with mifepristone. I would have tried it a month ago had the FDA granted my doctor permission to dispense it. I think there is a misunderstanding as to what is actually required. It's been a bit of a mess, but I still look forward to trying mifepristone. It might come to my having to use a different doctor whose participation can be overseen by an institutional review board. This normally means that the doctor must be affiliated with a university or perhaps be on the staff of a hospital that has one set up.
What I may do in the meantime is try taking dexamethasone for a few days. There is some precedence for doing this for people who are hypercortisolemic.
As for you, my best advice is to avoid evaluating drugs based on how you react to them during the first week. With as many drugs as you have tried, it is becomes imperative to give each treatment an adequate trial. I would return to Wellbutrin if I were you as long as you tolerated it well for the short time you took it. 300mg is practically mandatory. Wellbutrin makes for a good adjunct to other drugs if nothing else.
I would recommend starting at very low dosages of any drug and increase it very gradually so as to minimize startup side effects. These side effects seem to discourage you from continuing with treatment when they might in the end be of little consequence. You have not allowed yourself to work up to therapeutic dosages on quite a few drugs. You have also aborted treatment too early on most of them. You will very likely have to go back and retry these drugs.
You have so many options, I don't know where to start!
PERMUTATIONS. One would like to reduce the number of permutations to try by adding together as many drugs as is safe.
It might make sense to give nortriptyline 75mg a try immediately. If necessary, add Wellbutrin 300mg. If necessary, add Effexor 150-300mg. If necessary, add lithium 300-600mg. This will cover quite a bit and save a lot of time.
Don't discard mood-stabilizers or neuroleptics as adjuncts. You don't have to be bipolar or psychotic to benefit from these drugs. I would at some point try to establish lithium at dosages between 300-600mg. If you feel dysphoric or experience a flat affect after two weeks, you can cross it off your list. If not, you can continue taking it as you move through drug trials. Parnate + lithium / Lamictal can be a potent combination. You can even take Wellbutrin, nortriptyline, or desipramine in combination with Parnate. This is, of course, an aggressive treatment that most doctors will refuse to administer.
I think you should consider building a treatment around either an MAOI or Wellbutrin. The advantage to using the MAOI is that it probably has the best chance of getting you well. The disadvantage is that you cannot introduce drugs that inhibit the reuptake of serotonin with it. On the other hand, almost anything will mix safely with Wellbutrin.
Besides Lamictal, try and find a mood-stabilizer that agrees with you. Depakote and Trileptal are good choices. So now, you are taking Wellbutrin, lithium, and Trileptal. You are tolerating the combination well, but are not gaining an adequate antidepressant response. Now you start adding in your second antidepressant. Effexor would be my first choice. You still need to try Zoloft 200mg, so that might be next. If that doesn't work, I would keep all the drugs in place and add a third antidepressant - a tricyclic. I think nortriptyline at a dosage of 75mg would be best.
If you are experiencing absolutely no benefit, I would suggest discontinuing the antidepressants, retain the lithium and mood stabilizers, and add an MAOI.
You know, there are people who are biologically bipolar who never experience mania. Many people whom display depression only are of course treated as unipolar. It is only when these people fail multiple antidepressant treatments does it then dawn on the physician that he might be dealing with an unusual bipolar presentation and subsequently treat the patient successfully by adding mood stabilizers.
Are you bipolar or unipolar? Who cares? If you pretend that you are bipolar, you will have a better chance of getting well. You may have to revisit Wellbutrin, Prozac, Zoloft, Seroxat, and Remeron for lack of adequate trials (inadequate dosages and inadequate trial periods).
This has not been a well-composed post. It is more of a ramble so that you could gain some insight into previous treatment failures and future treatment successes.
- Scott
poster:SLS
thread:566744
URL: http://www.dr-bob.org/babble/20051010/msgs/566887.html