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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 6 to 30 of 36. Go back in thread:
Posted by Conundrum on December 15, 2010, at 22:33:14
In reply to Re: Looking for some med advice, posted by g_g_g_unit on December 15, 2010, at 21:06:25
> Did Adderall improve your focus/motivation at all?
I've only been on it for a few days, but no, doesn't do anything but make my heart beat faster.
> Is your pdoc open to prescribing MAOIs?
Perhaps, she said they're more effective than 1st line treatments, so maybe.
> Why wouldn't s/he prescribe a TCA in conjunction with a mood stabilizer, if mood instability was the issue?
I don't know. She said they're not much more effective than SSRIs, but my point is they work in a different way, and could be more effective for me. Perhaps, are antipsychotics mood stabilizers or just stuff like lithium, depakote, carbablahblahblah and all those other drugs I know nothing about? I've never heard they help with anhedonia though, I thought they work by slowing the mind down.
Posted by Conundrum on December 15, 2010, at 22:50:55
In reply to Re: Looking for some med advice, posted by Hombre on December 15, 2010, at 21:36:48
> I went from being a wreck to near remission on Remeron in a week, but it also started to poop out. Combining it with effexor xr seemed to do the trick. I noticed a surge of energy, jitters, and constipation with each dose increase of remeron and/or venlafaxine xr. I assume those were side-effects of increased levels of NE. It would go away after a few days, but overall the energy and interest I seem to get from the combination works for me.
>
> I tried reducing remeron, but I felt a bit flat. I'm not sure what it is doing now, but it seems to work synergistically with the effexor xr. I also take Seroquel, only 100mg, and that also helps brighten things up a bit as well as knocking me out cold every night. I tried reducing it to 50mg, but again felt a bit flat. I definitely need something that affects norepinephrine levels.Well she actually wants me to keep taking remeron, so maybe that would be similar with the prozac? I think the reason it poops out is because 5 HT2 receptor antagonism, is just not a very strong antidepressant mechanism and perhaps the addition of an agonist prevents upregulation or something, idk, i'm tired.
I'd wanted to try that combo too, but she didn't seem to keen on it. Effexor might be better than fluoxetine, which gives me more headaches and pristiq does not, so effexor probably wouldn't either.
Increasing norepinephrine seems to help with motivation. I'm wondering if a bigger bump in dopamine could help with creativity though. I'd like to come up with some good musical ideas again.
Posted by Hombre on December 15, 2010, at 23:25:51
In reply to Re: Looking for some med advice » Hombre, posted by Conundrum on December 15, 2010, at 22:50:55
Your results will vary, of course, but I find that remeron works with the effexor to increase NE, and I swear Seroquel, despite it's nighttime sedation, adds to the antidepressant effect. It is very similar to remeron in some regards, increasing pre-frontal NE and D through pre-synaptic HT receptor blockade (I forgot all the details, not that it really matters).
Yes, Seroquel does keep me from having racing thoughts, but I believe it is also working on NE and D to some extent. I think with Remeron or Seroquel, you might still need an SNRI to work on the "other end".
I believe zyprexa and seroquel can have an AD effect, and adding them to an AD, maybe an SNRI, could create a more balanced effect if you have any anxiety or soft bipolar symptoms. But it all comes down to what your body responds too, and sometimes you have to wait a while before the effect plateaus and you no longer feel the acute sedation, grogginess, etc.
Anyway, I just wanted to share my combo as an example of something that works, and maybe it can give you and your doc ideas. Even if she doesn't like the idea of adding effexor, too bad. It's one of Stahl's "Heroic Combos" and should be an option should you need some outside the box ideas.
Posted by Hombre on December 15, 2010, at 23:29:35
In reply to Re: Looking for some med advice, posted by Hombre on December 15, 2010, at 23:25:51
If you like, babblemail me and I'll send you the whole list of combos from Stahl's Essential Pharmacology.
Posted by Conundrum on December 15, 2010, at 23:49:25
In reply to Re: Looking for some med advice, posted by Hombre on December 15, 2010, at 23:25:51
> Your results will vary, of course, but I find that remeron works with the effexor to increase NE, and I swear Seroquel, despite it's nighttime sedation, adds to the antidepressant effect. It is very similar to remeron in some regards, increasing pre-frontal NE and D through pre-synaptic HT receptor blockade (I forgot all the details, not that it really matters).
>
> Yes, Seroquel does keep me from having racing thoughts, but I believe it is also working on NE and D to some extent. I think with Remeron or Seroquel, you might still need an SNRI to work on the "other end".
>
> I believe zyprexa and seroquel can have an AD effect, and adding them to an AD, maybe an SNRI, could create a more balanced effect if you have any anxiety or soft bipolar symptoms. But it all comes down to what your body responds too, and sometimes you have to wait a while before the effect plateaus and you no longer feel the acute sedation, grogginess, etc.
>
> Anyway, I just wanted to share my combo as an example of something that works, and maybe it can give you and your doc ideas. Even if she doesn't like the idea of adding effexor, too bad. It's one of Stahl's "Heroic Combos" and should be an option should you need some outside the box ideas.Thanks for the advice. Seroquel does increase norepinephrine. I know its metabolite is an NRI, but I dont' know how much of that comes into play in the brain. Are you taking higher dose effexor where there might be a dopamine effect.
Maybe if I can't get any results with the tools she is giving me I should find someone else? Well I know she prescribes seroquel, I've seen the samples in her office. I think I'm gonna go back on prozac and give it a few months. I know it will do something, and maybe building on something that kind of works is better than starting from scratch. I'd be more willing to start from scratch with an MAOI though, since they're supposed to be very powerful.
Now you got me thinking effexor + remeron might be stronger than prozac + remeron. Have you ever tried effexor on its own and did it work for more than a couple weeks?
Also, thanks for offering the list of heroic combos, I've found it online though. Unfortunately a lot of his combos use wellbutrin and stimulants which just don't work for me. Also TCA's are out for now.
Posted by morgan miller on December 16, 2010, at 0:55:46
In reply to Re: Looking for some med advice » Hombre, posted by Conundrum on December 15, 2010, at 23:49:25
That's too bad TCA's are out for now on account that your doctor doesn't like to use them. She should be more open minded. Maybe she just wants to cover all bases before resorting to TCA's.
Have you ever thought about Valdoxan?
I think a low dose of Lithium could possibly be a good adjunct to whatever antidepressant treatment you try. As long as lithium comes with very little or no noticeable side effects and it seems to help, it could be a staple for a very long time.
Posted by Hombre on December 16, 2010, at 1:22:36
In reply to Re: Looking for some med advice » Hombre, posted by Conundrum on December 15, 2010, at 23:49:25
I only take 150mg effexor xr. I took 75mg by itself a couple of years ago, well, with lorazepam and ambien, and while it did relieve most of my depression symptoms, I still had problems with anxiety, insomnia, and restlessness. But I felt so good that I weaned myself off of all the meds after about 6 months...and subsequently crashed a few months later.
I feel good on the combo I'm on, and I think the remeron and the seroquel make effexor much more bearable. Effexor is a bit enthusiastic in terms of raw energy, so having something else to smooth out the edges can change the way it feels. Again, I consider the supplements and regular exercise at least as important as the meds. The meds work with what you've got, and nutrition and exercise improve what you have to work with. Herbs work at an even more fundamental level, but that's another topic.
I reviewed the section on combos, and maybe I'm just repeating what you already know, but the addition of atypicals to SSRIs is described as being the best documented example of combining HT2A antagonism with serotonin reuptake inhibition.
There also seems to be a lot of different things you could try involving remeron, effexor, atypicals, SSRIs and NRIs. Since this kind of combination strategy is clinically effective for some, but not researched in depth, you can only go so far without actually trying things out. I wouldn't be surprised if wellbutrin felt different with remeron (did you try that? I forget) or an atypical. Who knows, just thinking out loud.
Since you respond partially to prozac and remeron, it would make sense to build upon one of those. If you don't like effexor after a week or so, I think you could get off of it with minimal discomfort. Short-term discomfort seems to be something we have to get used to during the frustrating trial-stage. It's worth it, IMHO.
Posted by Conundrum on December 16, 2010, at 2:22:30
In reply to Re: Looking for some med advice, posted by morgan miller on December 16, 2010, at 0:55:46
> That's too bad TCA's are out for now on account that your doctor doesn't like to use them. She should be more open minded. Maybe she just wants to cover all bases before resorting to TCA's.
I don't know if she dislikes them for people she thinks only have unipolar depression. She did mention desipramine causes constipation like it was the worst side effect in the world.
> Have you ever thought about Valdoxan?
Perhaps as an add on to a serotonergic drug. I found remeron which also works on the 5 HT2C receptor pooped out. Also abilify also works on post synaptic receptors, and while it gave me some drive at first it stopped working. Prozac blocks the 5 HT2C receptor but also agonizes it and other serotonergic receptors and doens't seem to poop out. However it causes really annoying headaches and sexual dysfunction, but at least it is consistent. Perhaps it would be useful for showing my doctor that I can hold a good mood? She says that the fact that I responded to some drugs then they stopped working shows I have mood instability. Honestly, I haven't been all that impressed by what I have read about Valdoxan, and it is really expensive. If I could afford it, it might make a good substitute for remeron without the weight gain.
> I think a low dose of Lithium could possibly be a good adjunct to whatever antidepressant treatment you try. As long as lithium comes with very little or no noticeable side effects and it seems to help, it could be a staple for a very long time.
I really don't think I need a mood stabilizer, but I would be willing to try them if it means I could take a tricyclic or MAOI then I would do it.
Posted by Conundrum on December 16, 2010, at 2:36:05
In reply to Re: Looking for some med advice, posted by Hombre on December 16, 2010, at 1:22:36
I had tried Pristiq and found that it seemed to do something, but only for a couple of weeks. So perhaps it would make more sense to start on the prozac and then add remeron or something else, since the prozac won't poop out. Interestingly, energizing effect from desvenlafaxine is what I liked the most. After awhile that went away and so did the "color"
> I only take 150mg effexor xr. I took 75mg by itself a couple of years ago, well, with lorazepam and ambien, and while it did relieve most of my depression symptoms, I still had problems with anxiety, insomnia, and restlessness. But I felt so good that I weaned myself off of all the meds after about 6 months...and subsequently crashed a few months later.
>
> I feel good on the combo I'm on, and I think the remeron and the seroquel make effexor much more bearable. Effexor is a bit enthusiastic in terms of raw energy, so having something else to smooth out the edges can change the way it feels. Again, I consider the supplements and regular exercise at least as important as the meds. The meds work with what you've got, and nutrition and exercise improve what you have to work with. Herbs work at an even more fundamental level, but that's another topic.
>
> I reviewed the section on combos, and maybe I'm just repeating what you already know, but the addition of atypicals to SSRIs is described as being the best documented example of combining HT2A antagonism with serotonin reuptake inhibition.
>
> There also seems to be a lot of different things you could try involving remeron, effexor, atypicals, SSRIs and NRIs. Since this kind of combination strategy is clinically effective for some, but not researched in depth, you can only go so far without actually trying things out. I wouldn't be surprised if wellbutrin felt different with remeron (did you try that? I forget) or an atypical. Who knows, just thinking out loud.It isn't just that wellbutrin didn't work, its that the tinnitus really scared me off it. It was pretty bad. So I wasn't able to tolerate wellbutrin.
>
> Since you respond partially to prozac and remeron, it would make sense to build upon one of those. If you don't like effexor after a week or so, I think you could get off of it with minimal discomfort. Short-term discomfort seems to be something we have to get used to during the frustrating trial-stage. It's worth it, IMHO.I think I would be able to tolerate effexor, i'm just thinking it might poop out in a couple weeks like pristiq did. Perhaps I will build upon prozac, since I don't think it will poop out. Ideally I'd like to take a TCA with it, and maybe an atypical. Actually I'd love to add low dose selegiline for some DA, but i think that is not allowed. It is ashame there aren't any pure dopamine reuptake inhibitors with long half lives, I think there is a big difference between the effects of stimulants and drugs that keep levels high constantly.
I know I should exercise, but it just seems so pointless, and I don't even wanna go outside its so nasty out. I'm not working right now, so no gym membership either. I am taking B vitamins now with my SAM-e but that is it.
I used to take a lot for a long time, but they just didn't help. Seemed like a waste of money. I even took a lot of vitamins in liquid forms to increase availability, but I dunno, something is wrong with my brain.
Actually took some remeron tonight, been off it for awhile, but the adderall I'm trialing (and its not working) makes it hard to sleep.
Posted by Hombre on December 16, 2010, at 6:04:35
In reply to Re: Looking for some med advice » Hombre, posted by Conundrum on December 16, 2010, at 2:36:05
It sounds like you have some good ideas, and I don't see why you are not allowed to follow through on some of them with the supervision of your doctor. If anything, trying new things gives some hope, even if they don't work. You can still learn from the experience. Even a short term period of near-remission means that it is possible, it's just the puzzle is not quite put together yet.
Exercise is the #1 X-factor in terms of depression, in my own experience. You can be doing everything right, even taking the right meds, but without a minimum of movement and breathing a little hard, the other stuff just doesn't work. Depression can be considered a state of stagnation. Expending energy forces the body to get better at creating energy, expelling waste, just functioning a little more efficiently. Not to mention the fact that exercise can reverse the atrophy to the hippocampus that results from chronic stress and depression. OK, I'll stop. Sorry!
Posted by morgan miller on December 16, 2010, at 10:11:00
In reply to Re: Looking for some med advice » morgan miller, posted by Conundrum on December 16, 2010, at 2:22:30
>I really don't think I need a mood stabilizer, but I would be willing to try them if it means I could take a tricyclic or MAOI then I would do it.
For a many people a low dose of lithium does not act as a typical numbing mood stabilizing agent. As you may have heard, low dose lithium has been used as an adjunct to antidepressants.
Posted by Phillipa on December 16, 2010, at 11:05:22
In reply to Re: Looking for some med advice, posted by morgan miller on December 16, 2010, at 10:11:00
After reading your thread it seems like prozac does do something. What about increasing the dose? It seems to work well for my Daughter. And boy I know what you mean about the cold, no money for gym, and going out to excercise. I keep going at night only on bike but it's become painful it's so cold. Phillipa
Posted by medamorphosis on December 16, 2010, at 16:00:23
In reply to Looking for some med advice, posted by Conundrum on December 15, 2010, at 14:57:28
> ...and if that is not enough try an MAOI?
>
>An MAOI can make many meds 'feel' very different. For me its like a solid all rounder - often filling in the gaps that another meds or combo seems to lack. And, apart from SSRIs, there not a lot (inc combos) which my doc isn't willing to prescribe with them. Perhapse even re-trying previous meds which didn't work, might be more efficient taken with an MAOI.
med
Posted by Conundrum on December 17, 2010, at 10:43:54
In reply to Re: Looking for some med advice » Conundrum, posted by medamorphosis on December 16, 2010, at 16:00:23
SSRIs at normal doses make me feel spacey, give me headaches, diarrhea, and sexual dysfunction. Do the MAOIs cause that kind of serotonin spaceyness, or do you think the increase in other chemicals balances it out?
> > ...and if that is not enough try an MAOI?
> >
> >
>
> An MAOI can make many meds 'feel' very different. For me its like a solid all rounder - often filling in the gaps that another meds or combo seems to lack. And, apart from SSRIs, there not a lot (inc combos) which my doc isn't willing to prescribe with them. Perhapse even re-trying previous meds which didn't work, might be more efficient taken with an MAOI.
>
> med
Posted by medamorphosis on December 17, 2010, at 11:13:35
In reply to Re: Looking for some med advice, posted by Conundrum on December 17, 2010, at 10:43:54
> SSRIs at normal doses make me feel spacey, give me headaches, diarrhea, and sexual dysfunction. Do the MAOIs cause that kind of serotonin spaceyness, or do you think the increase in other chemicals balances it out?
apart from perhapse the first week you'l feel fuzzy on maoi but the side effect generaly slowly creep up same time the med kick in then dies away after 2 months. But if your going down the MAOI route then its for the long term and side effects dont come into it. Thats my opinion, unless they're life threatening of course. But dude, SSRI effect are far more damagin with MAOIs overall being safer. Once on an maoi, and after it mellows out (ie, not enough anymore) It will still be there to boost any other meds that increase the catecholamines & tryptamines. GABA too in Nardils case. Best maoi for a good robust yet simple maoi effects seems isocarboxazid which I take. Cleanest MAOI. Nardil is great but id rather be on Marplan long term than Nardil. Can you get Marplan?
Also I've 'used' ritalin and amphetamine on Marplan and was fine. So if you think the an aswer in the future you should be able to keep the maoi.med
Posted by Conundrum on December 17, 2010, at 12:04:40
In reply to Re: Looking for some med advice » Conundrum, posted by medamorphosis on December 17, 2010, at 11:13:35
> > SSRIs at normal doses make me feel spacey, give me headaches, diarrhea, and sexual dysfunction. Do the MAOIs cause that kind of serotonin spaceyness, or do you think the increase in other chemicals balances it out?
>
> apart from perhapse the first week you'l feel fuzzy on maoi but the side effect generaly slowly creep up same time the med kick in then dies away after 2 months. But if your going down the MAOI route then its for the long term and side effects dont come into it. Thats my opinion, unless they're life threatening of course. But dude, SSRI effect are far more damagin with MAOIs overall being safer. Once on an maoi, and after it mellows out (ie, not enough anymore) It will still be there to boost any other meds that increase the catecholamines & tryptamines. GABA too in Nardils case. Best maoi for a good robust yet simple maoi effects seems isocarboxazid which I take. Cleanest MAOI. Nardil is great but id rather be on Marplan long term than Nardil. Can you get Marplan?
> Also I've 'used' ritalin and amphetamine on Marplan and was fine. So if you think the an aswer in the future you should be able to keep the maoi.
>
> medI don't know about Marplan, I know that in our family biology, my gmom was treatment resistant and responded to both nardil and parnate, I'm just worried that they will make my memory worse, or the serotonergic effects will be too much to take.
However, I have read about a lot of people saying Nardil really helps with anhedonia. I have not seen the same with Parnate, in fact the opposite more often.
Do MAOI's really cause noradrenaline to decrease, on wikipedia it says they do by displacing norepinephrine with octopime(SP?) but I respond well to increases in NE, so I'm not sure I want a drug that will decrease it.
Decisions, decisions.
Posted by medamorphosis on December 17, 2010, at 19:50:33
In reply to Re: Looking for some med advice » medamorphosis, posted by Conundrum on December 17, 2010, at 12:04:40
> I don't know about Marplan, I know that in our family biology, my gmom was treatment resistant and responded to both nardil and parnate, I'm just worried that they will make my memory worse, or the serotonergic effects will be too much to take.
>
> However, I have read about a lot of people saying Nardil really helps with anhedonia. I have not seen the same with Parnate, in fact the opposite more often.
>
> Do MAOI's really cause noradrenaline to decrease, on wikipedia it says they do by displacing norepinephrine with octopime(SP?) but I respond well to increases in NE, so I'm not sure I want a drug that will decrease it.
>
> Decisions, decisions.Never found Nardil nor Marplan make memory worse, quite the opposite. And your brain wont feel sapped with serotonin. Remember, SSRIs 'manipulate' the receptors directly. MAOI dont touch them like an SSRI, simply keeps whats there from becoming zapped by MAO. Norepinephrine? EASY. Use an NRI with your MAOI (bupropion, desipramine are safe. So should reboxetine & Straterra). NRIs have been proven to even help prevent tyramine attacks when used with MAOIs, esp reboxetine, a powerfull NRI! Though when MAOIs kick in they certainly give you drive. DA or NE, Something kicks in and picks you up. And serotonin aint the same feeling as an SSRI, but you'll feel its vast presence. NOT fuzzy but clear, hence why they're so good for social anxiety. Which seems to get worse when you're 'fuzzy'. Just my experiences.
med
Posted by ed_uk2010 on December 18, 2010, at 9:03:20
In reply to Looking for some med advice, posted by Conundrum on December 15, 2010, at 14:57:28
>It seems pretty good at speeding my heart up, but that is about it. I guess I just don't respond to stimulants.
Give it a little longer rather than increasing the dose. And then there's always methylphenidate and Dexedrine. Dexedrine is allegedly less 'peripheral'.
Posted by Conundrum on December 18, 2010, at 13:05:21
In reply to Re: Looking for some med advice, posted by ed_uk2010 on December 18, 2010, at 9:03:20
> >It seems pretty good at speeding my heart up, but that is about it. I guess I just don't respond to stimulants.
>
> Give it a little longer rather than increasing the dose. And then there's always methylphenidate and Dexedrine. Dexedrine is allegedly less 'peripheral'.
>
Hi thanks for your response. I'm not sure why taking it longer would make a difference with a stimulant. Also, I've tried ritalin and that didn't do anything either.
Posted by ed_uk2010 on December 18, 2010, at 13:21:39
In reply to Re: Looking for some med advice, posted by Conundrum on December 18, 2010, at 13:05:21
>I'm not sure why taking it longer would make a difference with a stimulant.
It might not. I just thought it might be worth a try since you've only been on it for a couple of day.
Posted by medamorphosis on December 18, 2010, at 13:24:35
In reply to Re: Looking for some med advice, posted by Conundrum on December 18, 2010, at 13:05:21
> Hi thanks for your response. I'm not sure why taking it longer would make a difference with a stimulant. Also, I've tried ritalin and that didn't do anything either.
>W-O-W! Just showes how we all are effected differenlty! Id be high and the wakefullness would go as long as I could make it when I take amphetamines. Perhapse a switch to Dex IS a good next step. Like ritalin it should be far more of a psycho-stim than a cardiac stim. Tho you'll get both probably.
Dont forget modafinil- can reach places other meds cant (dont ask me what that means but its true lol). Another tolerance builder for most, but just like some can hold onto an amphetamine dose for yrs so can some with modafinil.med
Posted by Conundrum on December 18, 2010, at 13:33:39
In reply to Re: Looking for some med advice, posted by ed_uk2010 on December 18, 2010, at 13:21:39
> >I'm not sure why taking it longer would make a difference with a stimulant.
>
> It might not. I just thought it might be worth a try since you've only been on it for a couple of day.Actually I think that is a good idea. I've been able to sleep a little better on it, so what can it hurt?
Posted by medamorphosis on December 18, 2010, at 13:52:24
In reply to Re: Looking for some med advice, posted by Conundrum on December 18, 2010, at 13:33:39
> > >I'm not sure why taking it longer would make a difference with a stimulant.
> >
> > It might not. I just thought it might be worth a try since you've only been on it for a couple of day.
>
> Actually I think that is a good idea. I've been able to sleep a little better on it, so what can it hurt?Helps with sleep? Wow, there really are opposite-type effects among US. You mention in ur signature that you have attention/distraction/concentration proprlems. Ever been tested for ADHA/ADD? Not meaning to worry you, just like to make sure you or your doc aint missed nothing ;)
med
Posted by Conundrum on December 18, 2010, at 14:16:23
In reply to Re: Looking for some med advice » Conundrum, posted by medamorphosis on December 18, 2010, at 13:52:24
Never been tested for ADHD, but I've suspected I have it. The fact that my motivation increases more with low dose prozac than stimulants makes me think it is more depression. Also I took prozac from age 16-21. Perhaps my brain is just dependent on it now for normal catecholamine release. :-/
Also amphetamines don't make me tired, its just that I am able to sleep a little better than I had initially, I had to take a remeron to get to sleep a couple times, but last night I didn't. Then again I went to bed at 4 am.
> > > >I'm not sure why taking it longer would make a difference with a stimulant.
> > >
> > > It might not. I just thought it might be worth a try since you've only been on it for a couple of day.
> >
> > Actually I think that is a good idea. I've been able to sleep a little better on it, so what can it hurt?
>
> Helps with sleep? Wow, there really are opposite-type effects among US. You mention in ur signature that you have attention/distraction/concentration proprlems. Ever been tested for ADHA/ADD? Not meaning to worry you, just like to make sure you or your doc aint missed nothing ;)
>
> med
Posted by Conundrum on December 18, 2010, at 14:20:44
In reply to Re: Looking for some med advice » Conundrum, posted by medamorphosis on December 18, 2010, at 13:24:35
> > Hi thanks for your response. I'm not sure why taking it longer would make a difference with a stimulant. Also, I've tried ritalin and that didn't do anything either.
> >
>
> W-O-W! Just showes how we all are effected differenlty! Id be high and the wakefullness would go as long as I could make it when I take amphetamines. Perhapse a switch to Dex IS a good next step. Like ritalin it should be far more of a psycho-stim than a cardiac stim. Tho you'll get both probably.
> Dont forget modafinil- can reach places other meds cant (dont ask me what that means but its true lol). Another tolerance builder for most, but just like some can hold onto an amphetamine dose for yrs so can some with modafinil.
>
> medI tried adrafinil and it seemed to make me more depressed, but there was some other stuff going on at the time.
If I dont' see a benefit with adderall, I'm not going to try any more stims. I seem to require 24 hour increases in neurotranmitters to have a strong psychoactive effect.
My main concern is between trying prozac again, waiting it out longer to see if the benefits grow, and if its only partially helpful augmenting. However my pdoc may only want to augment with an atypical antipsychotic. I'd rather try a tricyclic first for a number of reasons.
Or I could push for an MAOI and not know what effect it will have. Nardil sounds great for some ppls anhedonia, but I'm concerned about the big increase in serotonin. I don't respond well to normal doses of SSRIs. Parnate is interesting, but some say it makes them feel flat. Nardil has a higher incidence in causing mania, so I doubt my pdoc would prescribe it.
I hate feeling so indecisive and caught.
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