Posted by bleauberry on March 27, 2009, at 14:36:10
In reply to Stopping w. AD or not? I am feeling better?, posted by hansi555 on March 27, 2009, at 7:26:34
I tend to agree with SLS.
More and more I am coming to my own beliefs, similar to the ones Dr Gillman at PsychoTropical.com, that most "selective" antidepressants on their own really aren't very effective, and that a mixture of both serotonin and norepinephrine yields best results. That can be done with either a SSRI+TCA combination, or a MAOI like Parnate. Clomipramine by itself fits the bill, but side effects are more.
I did not mention the so-called SNRIs like Cymbalta or Effexor, because it is bordering on falsehood to call them dual antidepressants. Their actions on NE are miniscule. And, you can't vary them individually as you could with a combination.
Remeron is not the dual antidepressant it is claimed to be. That's because it does not produce serotonin toxicity syndrome when combined with an MAOI. Whatever action it has on serotonin is miniscule. Its primary action by a long shot, way far above anything else, is a powerful antihistamine.
Two points:
Try a mixture first. As long as you are on Nortrip already, add either Zoloft or Lexapro to it.
Insist on brand. Lexapro is not generic, so it will be brand anyway. If you go with Zoloft, insist on brand and refuse generic. I only say this because of how stern my doctor was on that topic, and he knows what he is talking about. Though it is kind of a toss-up, my doctor does prefer Zoloft.
I like the way Dr Gillman phrased it. Think of a 4-wheel drive vehicle. Would you want one that puts 90% of its power to one wheel and 10% to the others? If you go with either a TCA or an SSRI alone, that is what happens. For true 4-wheel drive performance with equal power all around, A TCA+SSRI is better, or an MAOI.
poster:bleauberry
thread:887227
URL: http://www.dr-bob.org/babble/20090322/msgs/887286.html