Posted by SLS on May 25, 2024, at 21:29:35
In reply to Auvelity responded but now incredible exhaustion, posted by pedr on May 24, 2024, at 7:46:26
> 👋 Hi folks,
>
> I am happy to see some of the old hands are still here and that this server is (just about) still kicking :) - PeterMartin, SLS, Hugh, Roslynn, Lamdage22 - and sorry to those Ive not mentioned/forgotten (the ol ECT, depression and the mountains of anti-depressants dont help with recall I find).
>
> This is my first post in many a year and Ill say up front, with my treatment-resistant {Depression,OCD,ADHD}, please dont be put out if I dont reply promptly. Writing anything is often very, very difficult.
>
> Enough bluster already, rando guy! - to my point: I recently reached the 12 month mark of VNS (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2990624/) without responding, which meant that yet another treatment had failed me and my PDoc who was managing the VNS said Have you tried Auvelity? I hadnt, and now I have, and after 3-4 days, my World expanded and some light was shone into it. It was surreal.FuckingBingo!
When I was a patient at the NIH, the clinical researchers were of the opinion that the type of improvement you experienced, should it not last but for a few days early in treatment, it was an indicator that a full response is likely to emerge later.
> However (theres always a however, isnt there?), I am now 14 days in and am experiencing some of the most intense exhaustion/somnolence/spotaneous sleeping Ive ever experienced - AND IVE BEEN ON NARDIL!!! /j
.
A few things to consider:
1. Not everyone reacts to Nardil with fatigue and tiredness. For me, it has always been stimulating.
2. Many side-effects appear at the beginning of treatment and either mitigate or disappear altogether as time passes. These are known as "startup side effects".
3. The same drug can have opposite effects on the same person, even if only one medication was taken in between trials. Simply said, the same drug is being administered to an altered, and therefore, a different brain.
4. Historically, people on Psycho-Babble picked up some critically counterproductive habits - the biggest one being not giving sufficient time to produce a clinical effect. They were switching between drugs, adding, subtracting, changing dosages, or using them intermittently.
> Basically, I know that a bunch of you are some of the smartest cookies on tinternets about drug cocktails, their SEs and the like and I thought Id see if anyone can spot any likely candidate interactions/? that might be behind this crushing exhaustion (I am squinting *incredibly hard* just to be able to see the text Im typing). So heres my regimen. Its a big one, inflated by pain management meds for spine surgery last year :> - 25 Lexapro,
> - ad-hoc 100mg provigil,
> - 15 Buspar
> - ~60mg Oxycodone
> - 2.5 Abilify
> - 2mg Lorazepam
> - 600 Lyrica
> - ~100 Ritalin
> - 100-150 Trazodone (usually I cannot sleep and this helps best of anything Ive tried)
> - Auvelity
> - Fetzima 40mg
> - Baclofen (I thought this was the cause but Ive trialled skipping it and the somnolence is unchanged)
> - 2400mg Ibuprofen (Surgeon prescribed)
> - 20mg Omeprazole (for NERD)That looks like a hell of a mess, but it could be the only way to treat your condition, which you should describe detail, including family history.
It might be very productive to make two lists:
1. Those treatments that produced an unequivocal improvement, even if only for a few days.
2. Those treatments that produced a significant increase in the severity of depression.
3. Those treatments that you were unable to tolerate because of side-effects. Were these startup side-effects?
4. Treatments for which you may not have fully explored higher dosages.
5. Treatments using "standard" antidepressants that you aborted prematurely - less than 6-8 weeks.
- TCA
- MAOI
- SSRI
- SNRI
- bupropion (Wellbutrin)
- nefazodone
- trazodone* More recently, non-standard antidepressant substances have been found that can produce an therapeutic response within hours to 2-3 days after the first dose. These include ketamine and esketamine (NMDA receptor antagonist), and psilocybin (5-HT2a agonism via its metabolite, psilocin). The FDA has sanctioned the study of psilocybin for depression. Results from clinical trials are encouraging.
Consider trying combinations of only those drugs that appear on list #1.Avoid those drugs that made you feel worse in the past.
Which drugs are you currently taking that you think might not be necessary?
- Scott
Some see things as they are and ask why.
I dream of things that never were and ask why not.The only thing necessary for the triumph of evil is that good men do nothing.
poster:SLS
thread:1122375
URL: http://www.dr-bob.org/babble/20230117/msgs/1122377.html