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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 2 of 2. This is the beginning of the thread.
Posted by gilmourr on June 13, 2013, at 14:36:09
I moved down from 45 mg to 30 mg because of the severe mood swings. I couldn't get lithium with Nardil yet so I wasn't able to use anything that would increase serotonin and help with sleep.
I figure 2-3 weeks since all that has to occur is MAO regeneration which takes about that long. So 2-3 weeks for an effect and then try something different, agree/disagree? Right now I'm not having mood swings, I just feel low almost all the time.
I did get trimipramine, so I may use that with 45 mg later... that would increase levels of serotonin mildly/antagonism of 5HT2 and the antagonism of alpha 1 would help decrease net NE at post synaptic receptors.
Hopefully I can get lithium when I see my psych.
Posted by SLS on June 13, 2013, at 23:57:48
In reply to SLS - How long would you wait to see an effect..?, posted by gilmourr on June 13, 2013, at 14:36:09
> I moved down from 45 mg to 30 mg because of the severe mood swings. I couldn't get lithium with Nardil yet so I wasn't able to use anything that would increase serotonin and help with sleep.
You might benefit from adding an antipsychotic to help prevent moodswings while you continue to explore antidepressant treatment. Some antipsychotics are known to produce antidepressant effects of their own. Seroquel, Latuda, and Abilify are the ones currently recognized as having antidepressant properties. However, Zyprexa and Geodon can be helpful as well.
Combining lithium with Lamictal can help reduce depression and rapid cycling. Even Trileptal should be considered as a mood stabilizer. Have you ever tried Depakote?
> I figure 2-3 weeks since all that has to occur is MAO regeneration which takes about that long.You don't need a complete restoration of MAO activity in order to produce a reduction in clinical effect. In my experience, reducing the dosage of Nardil only takes a few days to make a difference. If 5-HT2a antagonism is an effect you are looking for in a drug, nortriptyline is probably a better choice than trimipramine. Its effects at this receptor is quite potent. Nortriptyline is generally safe to combine with Nardil.
I recommend that you consider prazosin if you are looking for a NE alpha-1 receptor antagonist. It penetrates the brain easily and is the only drug I know of that will antagonize NE alpha-1b receptors and produce robust antidepressant and anti-PTSD effects. This receptor occurs infrequently, but appears in brain structures known to be associated with mood and fear.
- Scott
This is the end of the thread.
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