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Re: Tricyclics and bipolar depression » SLS

Posted by B2chica on March 21, 2016, at 15:01:15

In reply to Re: Tricyclics and bipolar depression » B2chica, posted by SLS on March 21, 2016, at 12:24:39

i am considered bipolar mixed, but i've always called it agitated depression because i dont get euphoric or grandiose. i feel horrible filled with disdain and contempt for myself and my world, i also can have illusions (which put me in place for psychotic depresssion dx once). right now i am dealing with severe psycho motor agitation. it is cycling though. one day horrible physical and mental depression, today mood good but horrible physical aggitation. a few days ago felt both simultaneously, it was Horrible.

Good News is that i just called my pdoc to update him on my condition and he liked the idea of adding a TCA but he wanted time to think on it. hes actually out of town this week but he is calling in a rx for topamax and agrees to cut down pristiq.
and i'm going to get an ativan now.
thanks for all your help scott!
dare i see a possibility of hope?
b2


> As I mentioned above, you may very well have a unipolar depression with psychomotor agitation that resembles the melancholic subtype. People with this kind of depression usually feel worse in the morning and experience more early morning awakenings. If this is indeed the case, a tricyclic antidepressant would be a good choice. I would choose nortriptyline. It is not usually activating and has mild anticholinergic side effects compared to amitriptyline. Amitriptyline is better for insomnia, though.
>
> If you are bipolar and will ultimately respond to a TCA, I would avoid those drugs that are serotonin reuptake inhibitors. The TCAs that are not SRIs include desipramine, nortriptyline, and trimipramine. Linkadge's suggestion of using doxepin is an interesting one. It tends to promote sleep and reduce anxiety. It is strongly antihistaminic. However, doxepin is not quite as effective for depression as are the other TCAs in my opinion. Still, it might work for you. Interestingly, trimipramine improves sleep architecture in depression, but I don't know how well it works for severe insomnia. I tried trimipramine and found it to be very tolerable. I think you are going to need to have a conversation with your doctor about trying a TCA either with or without adding Zyprexa, even if only temporarily.
>
> If you find amitriptyline to be effective for depression but intolerable, you can move to nortriptyline and perhaps employ Linkadge's strategy to combine cyproheptadine (Periactin) with melatonin for insomnia.
>
>
> - Scott


"What is madness, but nobility of soul at odds with circumstance.
The day is on Fire, and i know the purity of pure despair."
Theodore Roethke


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poster:B2chica thread:1087318
URL: http://www.dr-bob.org/babble/20160306/msgs/1087401.html