Posted by sowhysosad on April 1, 2009, at 16:55:06
In reply to Re: Fluoxetine/sertraline and dopamine, posted by desolationrower on April 1, 2009, at 4:30:28
> hi, sounds like you already know a lot about whats going on.
>
> i don't have expereicne with the meds your situation, but have you considered:
>
> DA agonists like pramiprexole
>
> low dose of selegiline - doc may say 'sure no problem' if she's got lots of pensioners, or freak out at ssri+maoi combo
>
> i'm not totally sure the cause of akathisia, but one of the 5ht receptor blockers might help. my guess is to get the sertraline to be dopaminergic the dose will really have to be pushed, so if 5ht is causing the problems it could be problematic. my guess is that fluoxetine would be better, but who knows. st johns wort might be worth trying, at least part of the moa seems to be serotonergic but it also has some dopaminergic component, among other things.
>
> -d/rThanks d/r - some great ideas there.
Unfortunately I'm not entirely sure selegiline is approved for depression in the UK and, even if it is, I wouldn't hold out much hope on an NHS pdoc prescribing it. They don't seem to like handing out unusual meds or combos if they can help it.
I had to protest VERY loudly before they'd even let me discontinue imipramine, even though it was evidently making my depression much worse (they actually suggested upping the dose by 25mg as a solution!).
Ditto with dopamine agonsists I'm afraid. I can't see the neuro prescribing one, as he's loathe to do anything that could interfere with my other meds. He previously mentioned a benzo like clonazepam, but based on my previous experience with diazepam I don't think it'll have much impact.
poster:sowhysosad
thread:887980
URL: http://www.dr-bob.org/babble/20090330/msgs/888081.html