Posted by bleauberry on December 4, 2008, at 17:59:21
In reply to Nortriptyline trial a failure?, posted by glennb on December 4, 2008, at 16:24:57
No way for any of us to know, but my guess is the thing that has been missing from the mix all along is an antipsychotic. Not for psychosis, but as a mood stabilizer and antidepressant turbocharger. For example, Prozac+Zyprexa; Lexapro+Risperdal. Since you are so familiar with Prozac, it might be a smoother more comfortable journey to go with it. Add zyprexa to it.
Prozac to me was similar to your experience with it. When my doc added zyprexa, it was at a time when the combo was just being discovered for its unique synergistic power. I was surprised to see it gave me great sleep, improved sexual function, cut the edge off prozac jitters, about a 60% improvevment in the dysthymia which always made me wonder if sometimes what we think is depression/dysthymia could actually be a moderate form of the negative symptoms of schizophrenia. They look so much alike. Anyway, we later added Adrafinil (Provigil's parent) and I was probably 90% cured for about 6 years. They were actually good productive years with only very distant traces of any lingering problems. I went for months at a time feeling perfectly normal with only a few scattered dysthymic hours here and there. I later discovered I was battling longterm low level chronic mercury exposure which eventually overwhelmed the great meds.
I would imagine a direct switch to prozac + zyprexa (probably 5mg), and shortly later at Provigil to it, you could be a different person.
A friend of mine with longterm depression was given lexapro + risperdal right from the start and he was already kicking in within 4 days.
Antipsychotics in combination do several things. They increase serotonin, NE, and DA levels in the brain from 100% to 300% more than the antidepressant alone. They partially block the receptors responsible for sexual dysfunction. The partially block the receptors responsible for anxiety/agitation.
The downside of weight gain should be ignored in a case like yours. Besides, I only gained 12 pounds. You do have to take on a new responsibility of eating healthy stuff geared toward good health and low weight. That is a ton better than a hospital or ECT.
ECT. Don't do it. I am a survivor. It sucks worse than words can describe. I see absolutely zero sense in even thinking about it until you've tried a prozac+zyprexa combo, lex+risp combo, provigil added to them, and a few other combos. ECT is for doctors who aren't creative enough with their prescription pads.
poster:bleauberry
thread:866692
URL: http://www.dr-bob.org/babble/20081204/msgs/866724.html