Posted by floatingbridge on January 27, 2011, at 14:04:07
In reply to Re: umm. advice from anyone tracking/knows me? » floatingbridge, posted by SLS on January 27, 2011, at 2:24:55
Scott, you saying add a tca's to the lyrica before trying an maoi--if I read you correctly. I know my gp mentioned some you did as the next step (if Lyrica fails).
Nardil scares me. I do have some vanity. I don't mind being mildly overweight, but Nardil has a rep.
The d*mn FM skews everything. Grrrr.
Hmmm. Let me know if I read you right. I would try the tca's.
Thank you for your thoughts. They have me thinking.
Like trying effexor--which I tolerated years ago.... I was thinking the more stimulating Maoi's like emsam or parnate. Fatigue +anxiety :-O
fb
> > 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 needed
>
> I 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
>
*keep a green tree in your heart
& a singing bird will come.
MDD & C-PTSD
poster:floatingbridge
thread:977855
URL: http://www.dr-bob.org/babble/20110115/msgs/978081.html