Posted by bleauberry on August 19, 2010, at 18:05:44
In reply to Monotherapy vs. Polytherapy for Depression?, posted by simcha on August 18, 2010, at 17:26:47
I personally do not believe any doctor should have a predisposed bias to either monotherapy or polytherapy. The good doctor knows that each patient is different and each requires a unique work of art in terms of drug choice.
I think it is important to pay attention to the clues our bodies gives us. Symptoms are clues. For example, if brain fog is an issue, lamictal makes no sense. That is not an anti-brainfog med. Mental confusion is actually a common side effect. As for depression, it has been clinically shown to "delay" the return of depression (assuming you are one of the lucky ones where it initially works), but relapse usually happened within 9 months.
Given your symptoms, my first choice would be ritalin. That has a good likelihood of kicking cymbalta into action and improving the brain and similar symptoms.
In a perfect world it would be nice to remove cymbalta and wellbutrin completely and start fresh with something like ssri+nortriptyline....a true SNRI (the current combo is seen as SNRI but actually is very weak at that). But, two years on cymbalta means some rough challenging times during a slow weaning. It is nasty to get off of after longterm use, generally speaking.
The brain fog could be from a biological reason...unsuspected chronic infection for example...but it could also be directly related to cymbalta, wellbutrin, and klonopin. For one or all of them to be making you foggy sounds reasonable to me.
I personally do not favor adding yet one more med to a cocktail of 3 that is not working. That makes no sense. Just gets you in deeper over your head, even harder to get out when it doesn't work. But if one is to be added, at the very least it should be one notorious for targeting the symptoms you have. Ritalin fits that description. Adding a second or third med to a first that is partially working sounds reasonable to me, but adding to 3 existing nonperformers I see no logic in that. It better be a darn good choice, and I'm sorry but I just don't see lamictal as being that.
IMO
poster:bleauberry
thread:959079
URL: http://www.dr-bob.org/babble/20100811/msgs/959163.html