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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by Christ_empowered on February 24, 2014, at 6:38:28
Can't take Wellbutrin...apparently, the combo has led to cases of TCA toxicity, which is something I'm not really looking for.
Can't take Provigil. No Ritalin or amphetamine preparations.
I was thinking Strattera (?). But that's more for adhd than anything else. Maybe I just need to either get the Neurontin back up to 900 or add in lamictal....
...ugh. Its like, the worst of the low mood quasi-psychotic "thing" is over, but I'm looking for remission. Maybe remission isn't going to happen thru pills?Plus, I've only been on Tofranil for 1 month...maybe give it some more time? Can you add Cymbalta or Effexor xr to tofranil, or will that kill you?
Posted by SLS on February 24, 2014, at 8:13:37
In reply to Boosting Tofranil, posted by Christ_empowered on February 24, 2014, at 6:38:28
Hi C_E.
> Can't take Wellbutrin...apparently, the combo has led to cases of TCA toxicity, which is something I'm not really looking for.
>
> Can't take Provigil. No Ritalin or amphetamine preparations.
>
> I was thinking Strattera (?). But that's more for adhd than anything else. Maybe I just need to either get the Neurontin back up to 900 or add in lamictal....
>
>
> ...ugh. Its like, the worst of the low mood quasi-psychotic "thing" is over, but I'm looking for remission. Maybe remission isn't going to happen thru pills?
>
> Plus, I've only been on Tofranil for 1 month...maybe give it some more time? Can you add Cymbalta or Effexor xr to tofranil, or will that kill you?
Have you ever taken Cymbalta or Effexor? What were the results?Why did you choose Tofranil (imipramine) over desipramine or nortriptyline?
I have been on a combination of Effexor 300 mg/day and nortriptyline 75 mg/day. It almost worked. There is no kinetic interaction between a TCA and either Effexor or Cymbalta.
Wellbutrin can be combined with a TCA as long as the dosage of the TCA is cut in half. I did this with Paxil when I combined it with desipramine. With nortriptyline, you can accomplish more precise dosing, as tests are available to assay blood levels. The blood levels that produce an antidepressant response are well researched. Also, with nortriptyline, you get 5-HT2a antagonism, something that does not occur with Tofranil. This property might help resolve negative symtpoms.
Keep an eye on Saphris (asenapine). It is an interesting drug that doea a lot of things, including 5-HT2a and 5-HT7 receptor antagonism. It also is thought to antagonize NE alpha-2a receptors like Remeron and Latuda do. I am currently taking Saphris for bipolar depression at a low dose of 5 mg/day. After taking it for a few days, it seems to be helping a little. I am surprised that I am not feeling worse, though. NE alpha-2a antagonists have hurt me in the past.
Q: Why would I take a drug that I expected to make me feel worse?
A: Because I never tried it before. Besides, who knows how accurate my paper theories are? Not me. Since I am often wrong, and no one else seems capable of guaranteeing a forecast of how I will react to a particular treatment, I am reluctant to skip over any.
Check out Brintellix (vortioxetine). It makes an interesting alternative to Cymbalta or Effexor, especially if you were to combine it with nortriptyline or some other norandrenergic TCA. Maybe even Remeron. With Brintellix, you get the SRI plus 5-HT7 antagonism and 5-HT1a partial agonism. This drug is not an antipsychotic, so you might need to look for one to use if you are not on one already. I think it is worth considering Latuda and Saphris to fill this role if you are unhappy with Abilify. These two drugs are supposed to help with negative symptoms and depression. Latuda is said to produce improvements in cognition - clarity of thought.
Given your history, I think you should *add* a new antipsychotic that you are trialing to the Abilify so that you have coverage to prevent relapse. If you respond well to the addition of a second antipsychotic, you can then gradually discontinue the Abilify and hope that the new drug does the job.
- Scott
Posted by Phillipa on February 24, 2014, at 8:57:48
In reply to Boosting Tofranil, posted by Christ_empowered on February 24, 2014, at 6:38:28
CE I had thought that Abilify at 3mg worked well for you? Phillipa
Posted by Christ_empowered on February 24, 2014, at 9:56:58
In reply to Re: Boosting Tofranil » Christ_empowered, posted by Phillipa on February 24, 2014, at 8:57:48
I take 30. Its OK...I mean, just an antipsychotic, you know? I don't think its worth all the hoopla, but it doesn't cause too many problems.
I just want remission of this depressive "thing," with the low-grade psychosis that comes with it...and I don't know how to make that happen....
Posted by phidippus on February 26, 2014, at 18:18:11
In reply to Boosting Tofranil, posted by Christ_empowered on February 24, 2014, at 6:38:28
What exaclty is your aim? To feel perfect? Or just better?
Strattera isn't a bad idea - norepenephrine reuptake inhitbitor. Should boost motivation and focus.
Eric
This is the end of the thread.
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