Posted by SLS on July 11, 2016, at 8:02:03
In reply to Re: Best AD for Melancholia » linkadge, posted by brynb on July 11, 2016, at 1:15:40
> hi linkadge,
>
> i have tried effexor (a long time ago) and remember disliking it. my doc initially mentioned adding SAMe, but as you said, is afraid it will trigger mania.
>
> i'm feeling a bit defeated right now but i very much appreciate everyone's responses and suggestions here. thanks so much for your response.
>
> -bIf you get stuck for ideas, I would consider using a tricyclic antidepressant (TCA). I would try desipramine first. It is milder in terms of side effects than imipramine. My impression is that nortriptyline isn't quite as effective for melancholia, but desipramine will feel "harsher" in the beginning of treatment. A partial improvement using desipramine might be an indicator that its parent compound, imipramine, will work better. If falling asleep (sleep initiation) is a problem, you could use amitriptyine instead of imipramine, but weight gain is more of a problem. If you fall asleep initially, but wake up in the early morning, and your depression is at its worst, desipramine/imipramine will actually allow you to sleep the night though once the depression improves.
If desipramine works pretty well, but lacks a mood-brightening effect, you might then try nortriptyline before moving to imipramine. I find myself in this categegory.
- Scott
Some see things as they are and ask why.
I dream of things that never were and ask why not.- George Bernard Shaw
poster:SLS
thread:1090338
URL: http://www.dr-bob.org/babble/20160609/msgs/1090378.html