Posted by bleauberry on August 1, 2010, at 12:48:57
In reply to What steps should I take?, posted by Dima on July 31, 2010, at 10:52:36
I personally don't find categorizing depression in this way or that as being very helpful. It is so subjective to variable interpretation and there are too many overlaps without clear boundaries.
What is much better, IMO, is to use the clues from med trials. They tell a story.
You probably do not have a serotonin deficiency issue. Your drug trials have shown that.
You may have a dopamine issue, by process of elimination, and by the clues given by adderall and abilify. Norepinephrine may be a player, but with the overdrive from nortriptyline norepeniphrine might be too high rather than too low.
I personally think a better stimulant is ritalin over adderall. And even if we assume you do not have a serotonin issue, either of those is likely to work better in combination with a serotonin med. Some kind of synergy.
If you were to stay with abilify, the kinds of doses that generally work better on your symptom cluster are in the 2.5mg to 5mg range, sometimes even as low as 1mg every other day, sometimes as high as 10mg. To go that high and avoid the awful akathisia would require a long gradual titration, but still no guarantee the akathisia would not happen. My own theory, unsupported and unproved, is that akathisia has a major cause being the NE antagonism most of the antipsychotics have...it causes a release of more norepinephrine, while blocking serotonin and dopamine. Think about it, that's pretty bizarre. No wonder the crawling out the skin feeling. Abilify just happens to have a lot of that in its profile compared to others.
If you wanted a somewhat energetic antidepressant antianxiety antipsychotic, I know of no better choice than 25mg-50mg of amisulpride. Mail order.
So I guess what I'm saying is, think dopamine. That narrows the field, but still the field of dopamine is pretty large. Lots of narrowing to be done within that field.
Simple home tests can give strong clues and sometimes total healing. I'm thinking DLPA and tyrosine.
Wellbutrin doesn't really count. It has minimal effect on dopamine and norepinephrine. Its actual mechanism is unknown, and its dopamine effects are glorified and overstated. So your failure on that one does not deter my opinions.
And these are just that, opinions. Based on your history, med clues, and symptoms.
poster:bleauberry
thread:956554
URL: http://www.dr-bob.org/babble/20100731/msgs/956727.html