Hi, Linkage.
> I found luvox was ok for sleep and anxiety, but not so much for depression. The sigma agonism of fluvoxamine could be useful if OCD or psychotic features were present (but it doesn't sound like this is the case).
What are the functions and locations of sigma receptors? I don't know anything about them. All I know is that agonists like Luvox reduce akathisia while antagonists like Zoloft can make akathisia worse.
> I don't think that trintillex is super potent as an SSRI (at least in therapeutic doses), the idea being that it's action at other sites seems to provide a theraputic effect with less potent action as an SSRI.
What do you think about combining Trintellix with Effexor? Are there any times where combining two SRIs is safe? If Trintellix helps with cognition and memory and Effexor is a stronger antidepressant, I may petition my doctor to combine them if Effexor is insufficient.
> I found escitalopram a better antidepresant than citalopram (marginally). It could be good to combine with something like bupropion.
You are likely right. I have seen people report that Wellbutrin combined with Zoloft or Effexor work well. A friend of mine achieved remission with Pristiq + Wellbutrin. She described Wellbutrin as giving her more energy while Pristiq gave her "the wanna dos". I take this as meaning improvements in interest and motivation, and perhaps anhedonia.
> The norepinephrine active drugs supposedly are more effective if high inflamation is present.
It would be interesting to have my CRP tested. Imipramine, desipramine, amitriptyline, and nortriptyline help me while protriptyline (high NRI) and reboxetine made me very, very much worse. Straterra was neutral.
> I don't suppose your doctor is able to test for markers of inflammation (not standard practice, but perhaps informative)?
He would do it. I just don't know if insurance will cover it.
> How is your blood glucose? Any prediabetes? Some studies show that drugs like piogitazone can augment standard antidepressants, even if glucose is marginally dysregulated. Pioglitazone is also a mild / moderate MAO-b inhibitor.
It doesn't surprise me that you should come up with such interesting ideas. I wish I had your memory. Glucose is fine, but my triglycerides are very high. My primary care provider thinks the Abilify is the culprit. I may ask to try metformin to tackle this.
> What about selegiline?
I tried it at 12 mg/24hr. It was neutral.
> I'm not sure how comfortable your doctor is, but supposedly it can be combined with SSRIs, at least in lower doses.
I would feel uncomfortable doing this. Even at 6mg/24hr, there is quite a bit of MAO-A inhibition. This is acknowledged in the manufacturer's label. In my estimation, MAO-A inhition results in most of the antidepressant effects of MAOIs. I don't know what to make of pargyline. Moclobemide is a reversable MAO-A inhibitor (RIMA). It makes for a potent antidepressant, but only for a few days to a few weeks - even at 1200 mg/day. The most potent antidepressant I ever took as monotherapy was clorgyline, an irreversible and specific inhibitor of MAO-A. I was with it at the US National Institutes of Health. Unfortunately, I wasn't allowed to add anything to it other than lithium. Ultimately, I stopped taking it because we couldn't get a stable mood state with it. I swung between euthymia and depression over the course of days. Clorgyline was discontinued for human consumption because of reports of cardiac sequalae. It is still used in the laboratory as a marker of MAO-A activity.
> Have you ever used dextromethorphan? (you didn't respond well to ketamine, if I recall..). Dextromethorphan, combined with bupropion or quinidine, may be useful.
Once I discontinue Parnate, I can try DXM. Ketamine was completely inert. I interpret this as my probably having the met66met genotype for the synthesis of BDNF. This is the worst genotype to have. It's always something with me.
> Celebrex may augment some antidepresants, again, if inflamation is high.
I might try naproxen. Celebrex gives me diarrhea.
> I still swear by pure cocoa powder and an anti-anhedonic strategy. Cocoa nibs are also useful. Also, as you know I've been trying medical marijuanna with relative sucess (more research is emerging on the use of cannabanoids for depression / anxiety). The cannabinoids THC and CBD are as potent at ppar-gamma receptors (action of pioglitazone) as they are at cb1 receptors.
I'm not familiar with ppar-gamma receptors. Interesting.
> Effexor and remeron do work very well together (apparently more effective than parnate for TRD) but the initial remeron sedation can be strong.
I'm afraid of Remeron. Another NE alpha2 antagonist made me feel horrendous. I began taking Remeron, but aborted it after only 2 days because I thought I was feeling a worse.
> Have you tried dopamine agonists (mirtapex is suppsedly effective for TR bipolar depression).
I haven't tried Mirapex. I just don't see anyone getting a consistent antidepressant effect from it. I do profit from Abilify, though. So maybe DA agonism is a good thing.
> There's some ideas, let me know if you want more.
I really do appreciate it.
- Scott
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