Posted by SLS on January 27, 2011, at 2:24:55
In reply to umm. advice from anyone tracking/knows me?, posted by floatingbridge on January 24, 2011, at 17:30:55
> Cymbalta 30mg
> Dex about 60mg
> Xanax xr about 1.5mg
> Xanax 0-1.5/2.0 mg as needed
> Ultram 200mg
> Lithium 300mg
> Norco 10-30mg as neededI was thinking more like a combination of Nardil and either amitriptyline or nortriptyline. You would have to discontinue the Ultram and the Cymbalta in order to use a MAOI. It's nothing too fancy. I would like to hear others' opinions on this. Nardil is often used successfully for treating anxiety disorders.
You know, it is frustrating to have so few proven tools to work with for treating FM. I know a doctor who used sibutramine to treat FM. He claimed it was a miracle drug. Sibutramine is no longer available in the US. However, that it is a SNRI is interesting. I guess that's just a little more evidence that combining the reuptake of serotonin and norepinephrine might be something to try along with Lyrica. You could perhaps combine a SSRI with nortriptyline of desipramine. Desipramine isn't chosen as often.
You might want to add a tricyclic now. You could go with amitriptyline. It is a proven entity. Its daughter metabolite, nortriptyline, might be as effective, but has not investigated as often. The problem with amitriptyline is that it can produce sedation, weight-gain, somnolence, and anticholinergia as side effects. You could try NOR first, and go with AMI if necessary. People become tolerant of TCA side effects after prolonged treatment.
I do know one woman who was able to combine Nardil with doxepin. Doxepin can be calming and promote sleep, although I don't know how it affects sleep quality. It is a potent antihistamine.
And then there is trimipramine. This drug is atypical for a TCA. It does not inhibit the reuptake of neither NE nor 5-HT.It produces improvements in sleep architecture and can be calming. Although I don't know anyone who has combined trimipramine with a MAOI, it might be worth looking into. It is sometimes chosen for FM.
Add Lyrica and see how you react to it. You might then add a TCA after you are convinced that Lyrica is not making your depression worse.
That seems like such a mess, but no more complicated than what you are taking now.
What are your thoughts on these treatments?
- Scott
Some see things as they are and ask why.
I dream of things that never were and ask why not.
poster:SLS
thread:977855
URL: http://www.dr-bob.org/babble/20110115/msgs/978057.html