Posted by bleauberry on July 13, 2009, at 17:26:39
In reply to Best Bipolar II with depression cocktail?, posted by ajax1 on July 12, 2009, at 21:55:32
First a disclaimer. No matter what me or anyone has for suggestions, prediction of results is impossible. So the best we can do is to try to narrow the list down to things that would fit the uniqueness of you. So for depression, bipolar, sleep, and med sensitivity, these are the things that came to the top of the list in my thinking:
Zyprexa + Nortriptyline; possibly a tiny amount zoloft added (3mg-12.5mg); naturals magnesium trial and bedtime baked potato; different food choices.
Zyprexa is the mood stabilizer, the antidepressant booster, and sleep friendly.
Nortriptyline is the antidepressant, pain reliever, and sleep friendly.
Being a sensitive patient myself, and having done poorly just like you on the meds you listed, the above meds are do-able.
No ssris. If anything at all, maybe a tiny bit of zoloft with the nortriptyline.
Doses. Zyprexa start at 2.5mg with a target of 5mg, going in 1.25mg or .6mg steps (by cutting pills). Nortriptyline. Start at 5mg (half of the smallest capsule 10mg). Increase both as tolerated, with your side effects and emotions as the guide, versus a predetermined schedule. Basically that will probably mean re-assessing what to do about every 4 to 7 days, and then either staying there for another 4-7 days or taking a small jump up.
I don't like seroquel and am puzzled why doctors use it so much. Zyprexa is by a million miles a much better all-around medication. Some people like their seroquel, but for most of them its benefits are in sleep but not anxiety or depression. I much prefer the sleep quality that nortriptyline gives.
Neither of the two meds I suggested have the knockout elephant dart punch that seroquel has. But they will allow you to drift off to sleep and experience a good quality sleep.
I cannot overstate...with med sensitivities, you gotta be extra cautious with the initial dose choices so as to be able to stay the course and not to be stopped early. No dose is too small. But it is very easy for any dose, no matter how small someone else might think it is, to be too much too fast for people like you and me. The secret for med sensitive patients is to ignore the doses of other people, ignore the manufacturer doses, ignore the clinical trial doses, ignore the doses of the doctor's other patients, and instead think in terms of 1/4 or 1/2 of those, especially in the first few weeks. You are not only sensitive to the negative sides of the meds, but the positive sides as well, which means you likely won't need as much as someone else.
Roaming through pubmed for relentless hours shows some interesting trends. 1) People who tolerate SSRIs poorly tolerate TCAs much better. 2) Older frail people tolerate TCAs better than SSRIs, and they are more effective. The one exception to the rule might be zoloft.
Natural things to do in order to address underlying problems. Try magnesium supplements. Start with low doses, increase as tolerated. They should provide some smoothness to life and better sleep. They can be antidepression for some people but pro-depresesion for others. A easy quick test is an epsom salts bath. A cup of epsom salts in a warm bath for 20 minutes near bedtime. You will directly absorb the magnesium. You can adjust doses by amount of salt and length of time. I find this method of magnesium delivery tolerable and helpful while supplements are not. Magnesium is sort of in the lithium family. Not sure if you have tried lithium, but low doses of it could be on your watch list, but only with a TCA and not SSRI.
For food choices, focus mostly on veggies and proteins. Very little sugars, very little caffeine, go easy on carbs such as breads, buns, pizzas. No dunuts or anything like that. It is a tough change for most people, but almost universally helpful no matter what the psychiatric problem is, given about two months. I had no choice since I found I was gluten intolerant. But now months later I must admit I prefer my current way of eating over the burgers and pizzas and donuts I used to eat all the time. I don't miss them anymore, but I missed them badly at first. Almost like breaking an addiction. Chocolate is my thing. So I eat it 85% dark to avoid most of the sugar.
And this will sound weird. But true. A baked potatoe with its skin each night about an hour before bed. Long story how it works. I think the book written about it "Potatoes Not Prozac" is a little aggressive in thinking this strategy is the answer to sleep and depression, and though it may not be a miracle cure, it is definitely worth a few points on a 1-10 scale.
Zyprexa, Nortriptyline, food choices, magnesium, bedtime baked potato. Really. :-) For emergency sleep issues, Amitriptyline first choice, Lunesta second choice. If nortriptyline should unexpectedly prove to be nonhelpful for sleep, then amitriptyline would be the choice.
I am very sensitive. So for me to mention any of these things at all says a lot about them.
poster:bleauberry
thread:906477
URL: http://www.dr-bob.org/babble/20090709/msgs/906577.html