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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by gman22 on September 4, 2023, at 11:29:48
Looking for feedback on this as a possible combination...Or if I take just two of them, which ones would be the best and safest to take long term.
Thanks
Posted by SLS on September 4, 2023, at 17:54:20
In reply to nortriptyline+sertraline+methylphendate, posted by gman22 on September 4, 2023, at 11:29:48
> Looking for feedback on this as a possible combination...Or if I take just two of them, which ones would be the best and safest to take long term.
> ThanksI can't speak to the benefits of taking methyphenidate to produce a true antidepressant effect, even when used in combination with other medications. It most often gives someone more mental energy, but that seems to be more of a palliative measure than a therapeutic one. Have you read or heard of methylphenidate producing a true remission? I just haven"t personally seen miracles with it. If it helps palliatively onle, it makes sense to use it until you find an effective antidepressive treatment.
Your proposed combination of nortriptyline plus sertraline is well thought-out. The neurotransmitters that are inhibited by these two drugs are complementary. I know that most antidepressants have properties in addition to reuptake inhibition, but I don't know enough about them to put together a coherent explanation that includes them. At this point in history, scientists still struggle to put together a neurobiological explanation for the etioloogies of mood disorders. They are equally uncertain as to why certain substances work to treat them.
Research into the psychobiology of affective disorders is fascinating and stimulating. But for now, it is *clinical* research and the anecdotes of psychiatric practitioners that guide treatment. Clinical practice still relies more on observation than theory. I don't know everything regarding how the drugs that brought me to remission work. I just know that they do. My choices of drugs is very much based upon my treatment history and how I reacted to each drug I've tried along the way. Perhaps you can follow a similar line of thought.
These drug combinations have been observed to produce therapeutic results. It is meant to be an all-inclusive list.- Sertraline + venlafaxine (or desvenlafaxine)
- Sertraline + bupropion
- Venlafaxine + bupropion* Add LOW-dosage lithium to any regime (as long as mania is not a feature of your illness). I absolutely need lithium 150mg/day to produce remission. However, lithium 300 mg/day or higher produces a deterioration in my condition that is effectively a relapse.
* Add lamotrigine 150-300 mg/day to any treatment regime.
Over the years, my best responses have come from a MAOI + TCA combination. MAOI monotherapy has also produced positive results. Right now, the following four drugs are necessary to be used to produce remission:Phenelzine (Nardil) - 90 mg/day
Nortriptyline (Pamelor) - 100 mg/day
Lamotrigine (Lamictal) - 300 mg/day
Lithium (Li2CO3) - 150 mg/dayA successful psychiatrist will confer with colleagues on a regular basis to exchange observations and experiences.
Fluoxetine (Prozac) is underutilized. This being the case, there isn't much clinical information regarding its use in polypharmacy. Fluoxetine generally produces more mental energy rather than fatigue or sedation. It also has a lower liability for weight-gain and a reduction in sex drive, although it might delay orgasm. Apathy is not seen as frequently or as robustly than with other SSRIs.
* Again, these are generalizations. If you line up 10 people, you might get 10 different reactions to the same drug.Good luck.
- Scott
Posted by undopaminergic on September 5, 2023, at 2:19:54
In reply to Re: nortriptyline+sertraline+methylphendate » gman22, posted by SLS on September 4, 2023, at 17:54:20
> > Looking for feedback on this as a possible combination...Or if I take just two of them, which ones would be the best and safest to take long term.
> > Thanks
>
> I can't speak to the benefits of taking methyphenidate to produce a true antidepressant effect, even when used in combination with other medications. It most often gives someone more mental energy, but that seems to be more of a palliative measure than a therapeutic one. Have you read or heard of methylphenidate producing a true remission? I just haven"t personally seen miracles with it. If it helps palliatively onle, it makes sense to use it until you find an effective antidepressive treatment.
>I'm not sure how you differentiate palliative and therapeutic.
Methylphenidate (and the like) produces a fast response. The difference between without it and with it was like night and day in my case. It helped for energy, and against apathy (including poverty of thought) and suicidal ideation, within minutes of its administration. Typically, it helps only for as long as one takes it, but I've sometimes seen the effects linger.
Although I wrote that the contrast between not using it and doing so was like night and day for me, it did not produce full remission.
-undopaminergic
Posted by SLS on September 5, 2023, at 7:50:28
In reply to Re: nortriptyline+sertraline+methylphendate » SLS, posted by undopaminergic on September 5, 2023, at 2:19:54
Hi, Folks.
> > > Looking for feedback on this as a possible combination...Or if I take just two of them, which ones would be the best and safest to take long term.
> > > Thanks
> >
> > I can't speak to the benefits of taking methyphenidate to produce a true antidepressant effect, even when used in combination with other medications. It most often gives someone more mental energy, but that seems to be more of a palliative measure than a therapeutic one. Have you read or heard of methylphenidate producing a true remission? I just haven"t personally seen miracles with it. If it helps palliatively onle, it makes sense to use it until you find an effective antidepressive treatment.
> >
>
> I'm not sure how you differentiate palliative and therapeutic.
This might be a useful example:Social Anxiety Disorder:
- Therapeutic (Nardil): The remission of all psychological and somatic symptoms of Social Anxiety Disorder.
- Palliative (Xanax): A treatment modality that is meant to reduce the symptoms of anxiety in Social Anxiety Disorder while searching for an effective treatment for the disorder itself.
> Methylphenidate (and the like) produces a fast response.Absolutely, but you have not attained remission with any of them. Why else would you stop taking them? These drugs are only of palliative value to you. Any other semantics are moot.
Like I said, you can give 10 different people the same drug and get 10 different reactions. I imagine a very, very small percentage of people glean a true therapeutic antidepressant response using methylphenidate monotherapy. At best, methylphenidate serves as a true adjunct to other drugs to produce a true remission. This is not the case with you, though. For you, I see methylphenadate as being palliative.
Since I'm not inside you, I can't know what remission feels like for you. I only know what it feels like for me. I'm not entirely sure that you know what remission feels like for you, though. You may have forgotten. If you can remember a time when you felt best, either before or after the onset of your illness, it might be critically important for you to re-experience that state of consciousness. It would serve as a means by which any current treatment can be measured and evaluated by you. Remembering what it felt like to have my mind free of depression served as my carrot, with uncertainty being my source of hope.
- Scott
Posted by undopaminergic on September 10, 2023, at 1:02:02
In reply to Re: nortriptyline+sertraline+methylphendate » undopaminergic, posted by SLS on September 5, 2023, at 7:50:28
> >
> > I'm not sure how you differentiate palliative and therapeutic.
>
>
> This might be a useful example:
>
> Social Anxiety Disorder:
>
> - Therapeutic (Nardil): The remission of all psychological and somatic symptoms of Social Anxiety Disorder.
>
> - Palliative (Xanax): A treatment modality that is meant to reduce the symptoms of anxiety in Social Anxiety Disorder while searching for an effective treatment for the disorder itself.
>
>
> > Methylphenidate (and the like) produces a fast response.
>
> Absolutely, but you have not attained remission with any of them.Complete remission? No. Partial remission? Yes.
In fact, methylphenidate (and the like) attacks the absolute *core* symptoms right away.
> Why else would you stop taking them?
It wasn't my intention to do so.
> These drugs are only of palliative value to you. Any other semantics are moot.
>
> Like I said, you can give 10 different people the same drug and get 10 different reactions. I imagine a very, very small percentage of people glean a true therapeutic antidepressant response using methylphenidate monotherapy. At best, methylphenidate serves as a true adjunct to other drugs to produce a true remission. This is not the case with you, though. For you, I see methylphenadate as being palliative.
>
> Since I'm not inside you, I can't know what remission feels like for you. I only know what it feels like for me. I'm not entirely sure that you know what remission feels like for you, though. You may have forgotten.
>I have an abstract understanding of what remission is for me, but I can't recall the feeling itself.
> If you can remember a time when you felt best, either before or after the onset of your illness, it might be critically important for you to re-experience that state of consciousness.
>I did re-experience it once, when I was (hypo)manic.
-undopaminergic
Posted by SLS on September 10, 2023, at 6:31:27
In reply to Re: nortriptyline+sertraline+methylphendate » SLS, posted by undopaminergic on September 10, 2023, at 1:02:02
> > >
> > > I'm not sure how you differentiate palliative and therapeutic.
> >
> >
> > This might be a useful example:
> >
> > Social Anxiety Disorder:
> >
> > - Therapeutic (Nardil): The remission of all psychological and somatic symptoms of Social Anxiety Disorder.
> >
> > - Palliative (Xanax): A treatment modality that is meant to reduce the symptoms of anxiety in Social Anxiety Disorder while searching for an effective treatment for the disorder itself.
> >
> >
> > > Methylphenidate (and the like) produces a fast response.
> >
> > Absolutely, but you have not attained remission with any of them.
>
> Complete remission? No. Partial remission? Yes.
>
> In fact, methylphenidate (and the like) attacks the absolute *core* symptoms right away.
>
> > Why else would you stop taking them?
>
> It wasn't my intention to do so.
>
> > These drugs are only of palliative value to you. Any other semantics are moot.
> >
> > Like I said, you can give 10 different people the same drug and get 10 different reactions. I imagine a very, very small percentage of people glean a true therapeutic antidepressant response using methylphenidate monotherapy. At best, methylphenidate serves as a true adjunct to other drugs to produce a true remission. This is not the case with you, though. For you, I see methylphenadate as being palliative.
> >
> > Since I'm not inside you, I can't know what remission feels like for you. I only know what it feels like for me. I'm not entirely sure that you know what remission feels like for you, though. You may have forgotten.
> >
>
> I have an abstract understanding of what remission is for me, but I can't recall the feeling itself.
>
> > If you can remember a time when you felt best, either before or after the onset of your illness, it might be critically important for you to re-experience that state of consciousness.
> >
>
> I did re-experience it once, when I was (hypo)manic.
>
> -undopaminergic
This is a good thing. Replay it in your mind from time to time. It is a concrete reason to have hope and make that state of mind your goal - minus the manic reaction (if you can).
As always, I wish you luck in finding what you are looking for. For some reason, I have an easy time praying for you - much more so than I can muster for myself. Strange.
- Scott
This is the end of the thread.
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