Re: SLS

> > Actually, my suicidal reaction to reboxetine occurred in the absence of a MAOI. I don't recall if I was taking any other drugs at the time.
>
> Okay, I'm sorry to hear you had such a bad reaction.

I found reboxetine to be anxiogenic. I wasn't paralyzed with anxiety, but it did add to the suicidal state I found myself in.

> > > I'm trying to reduce daytime fatigue and I was thinking of adding a small dose of reboxetine in the morning.

> > I've been using Focalin (dexmethyphenidate) to use as a PRN for difficult days. One can add it to a MAOI safely.

> Interesting, I have seen suggestions that if you add a stimulant you should start with a small dose and titrate, how does it work when you take it PRN? How large dose do you take?

I was told that I could take Focalin at 20 mg/day (10 mg b.i.d.). Like I said, I have been using it sparingly as a PRN. I don't know if I would build up a tolerance were I to take it daily. Personally, I would think D-amphetamine (Dexedrine) would be smoother than methylphenidate. So, if you find methylphenidate to be anxiogenic, that doesn't guarantee that amphetamine will also produce anxiety.

> My concern with adding stims is increased anxiety, but there are drawbacks with every option. Bupropion is also an option, but there is not much information on this combination. I have added 450 mg/day of bupropion to Parnate. There were no adverse effects other than it worsening my depression to a moderate degree. This occurs with bupropion monotherapy, too.

> > I don't see how nortriptyline would represent a greater risk than reboxetine when added to Parnate. Supposedly, one should add the MAOI to ongoing TCA treatment. I don't understand the rationale for this, though. I have not seen any evidence to support this notion. I have added TCA to ongoing MAOI treatment a number of times.
>
> I don't understand it either, as with much of the information regarding MAOIs, it can be a myth and/or based on outdated/incomplete data. Everything is deemed unsafe unless there is a clinical study that confirms its safety (as it should).
>
> > I don't know what to make of agomelatine. I have seen it reduce rapid-cycling in bipolar 2 disorder. It had no therapeutic effect for me, but I was not taking a MAOI at the time. Perhaps the melatonin M1 an M2 receptor stimulation helps to regulate biological clocks. For depression, my guess is that the 5-HT2c antagonism participates in producing a treatment response.
>
> I have no experience of it, if 5HT2C disinhibits NE and DA it could combat tiredness, but it's a long shot. It could be great for sleep.

> > Thanks. I have had a difficult few days, both biologically and emotionally. Latuda made me feel significantly worse upon continued treatment and dosage increases, and I have run out of ideas for pharmacotherapy. Perhaps TMS is the next step. I am not feeling terribly optimistic.

> I'm sorry to read this, Scott. You're one of the few guys that have the know-how and courage to try combinations no one else has, making new treatments a viable option for others.

The severe depressive state that I found myself in generated negative thoughts and the beginnings of suicidality. My outlook was pessimistic. I'm better today, and not as pessimistic. I don't have handfuls of treatment ideas, but I might revisit Saphris (asenapine). I don't recall why I discontinued it prematurely. I don't think it made me feel worse. I was probably just impatient.

One study I came across compared ECT, [shallow] rTMS, and deep TMS. ECT was most effective, but deep TMS was not very far behind. rTMS was only slightly effective by comparison. One weird outcome was that deep TMS at two weeks was better than at four weeks, as there was a higher drop-out rate at four weeks. The authors observed that there were tolerability issues with deep TMS.

I have tried both amantadine and memantine. I didn't feel any better, but I didn't feel any worse.

Some see things as they are and ask why.
I dream of things that never were and ask why not.

- George Bernard Shaw

Re: SLS

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