Posted by bleauberry on August 19, 2010, at 18:15:40
In reply to Depressed Again. Haven't been here in years., posted by simcha on August 18, 2010, at 16:06:44
> Folks, I'm coming to you again after having a few good years with my MDD with recurrence. Currently I'm on the following regimen:
>
> Morning:
> 60mg Cymbalta
>
> Evening:
> 450mg BuproprionXL
> .5-1mg of Klonopin for restless legs
> 25mg Trazodone for insomnia
>
>
> He said that I should investigate the following meds:
>
> Remeron
> Lamictal
> Abilify
>
> My brother is on Remeron. He used to be quite thin. He isn't anymore. The medication makes mornings groggy for him. I'm not a morning person. I'm not a thin guy. I'm already a big guy. Anything that makes you gain weight is not going to work for me.
>
> Abilify scares the crud out of me. I already have borderline high cholesterol and this drug increases serum cholesterol. Beyond that it can encourage diabetes. Also there is a significant risk of Akathisia. I already have restless legs, so I don't want that.
>
> Lamictal sounds more benign but is it really all that effective for depression? Also there is the chance of getting a rash. I've had allergic reactions to some medications in the past and they are not fun.
>
> In the past I've already tried EffexorXR (effective but major impotence and intensely horrific withdrawal).
>
> I was on Neurontin for the longest time, gained weight and it didn't really seem to do much of anything.
>
> Celexa was also in my mix. It pooped out.
>
> I have no clue what to tell him. I don't know what would be best. Should I get off of the Cymbalta and have it replaced by Remeron, Abilify, or Lamictal eventually? Anyone have any suggestions or experiences to offer. I'd appreciate it.Of everything you said above, one thing jumped out at me...celexa was in the mix but pooped out.
That would have been the perfect time to add nortriptyline, not some other new age drug. SSRI+TCA is hard to beat. Why they go for the exotic drugs instead, I have no clue. My own theory is that when an ssri poops out, it is because the body can longer keep up the struggle to elevate norepinephrine to match the artificially high serotonin. That's where the TCA comes in.
You doctor is a doctor, and I am not. Regardless, I would shun all three meds he suggested, for all the reasons you mentioned plus some of my own. Better choices IMO would include LDN, Nortriptyline, Ritalin, and the natural supplement DLPA.
Of the 3 meds he suggested, I personally might consider a short trial of abilify at no higher than 1mg to start with, and a ceiling of 5mg. Go from there depending on what happens. The other meds, forget it. Just my opinion though.
poster:bleauberry
thread:959064
URL: http://www.dr-bob.org/babble/20100811/msgs/959164.html