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Re: What do I do about this leftover depression?

Posted by LouisianaSportsman on April 4, 2014, at 22:37:37

In reply to What do I do about this leftover depression?, posted by phidippus on March 27, 2014, at 19:48:44

Lithium 1200 mg
Lexapro 20 mg
Geodon 160 mg
Vyvanse 70 mg

I know you have tried a plethora of medications. Well, at this point, it seems that you might need to try a MAOI; obviously, that would remove the Vyvanse therapy which I know is an effective medication for you. Dont be alarmed as your ADHD can be managed using other stimulatory management.

This leaves use with:
Lithium 1200 mg
Lexapro 20 mg
Geodon 160 mg

Yes, I believe we should add an a MAOI; however, I believe it may be good to augment your Lexapro with an agent. Have you considered cabergoline (Dostinex)? Cabergoline, a dopamine receptor agonist, has an antidepressant-like property and enhances brain-derived neurotrophic factor signaling. Cabergoline exerts antidepressant- and anxiolytic-like effects, which may be mediated by potentiation of intracellular signaling of BDNF.,_Cabergoline,_to_a.5.aspx We present herein 2 patients with depression who showed dramatic improvement of treatment-refractory energy loss, fatigue, and lack of motivation when a dopamine agonist, cabergoline was added to a serotonin-noradrenalin reuptake inhibitor (SNRI), milnacipran.

There are also other dopamine agonists, but I feel like you may have tried them already? Also, ignore the dosages suggested. I think it is worth a shot.

I feel like youve already tried so many things that I would suggest. I have lots of other strategies, but I feel they are not appropriate for you since you're a veteran.

I dont think that pindolol would hurt anything as well. Once-daily high-dose pindolol for SSRI-refractory depression. In addition, results reported here suggest that a single high dose of pindolol (7.5 mg) is a more effective augmentation strategy in SSRI-refractory patients compared with the same total dose given at 2.5 mg tid.

Now we have:
Lithium 1,200 mg
Lexapro 20 mg
Geodon 160 mg
Cabergoline 2mg.
Pindolol 7.5mg.
Nardil 75mg.

Nardil is obviously the MAOI I suggest for you. You may still need to augment, however.

I suggest adding trimipramine (Surmontil) H1 antagonism + 5HT2A antagonism + alpha 1 antagonism that might help the excess NE issues with more NE then going to alpha 2 which can inhibit NE. I think there might be some literature on this combo too. This TCA looks smooth with Nardil.

Lyrica (or gabapentin) is an AMAZING choice. I cant rave about it enough. Definitely a mood brightener. But, I found I ran out of my maxed out script early and ended up paying two people to go get scripts for me and was taking 1,200-2,400mg. of Lyrica a day. I also had connections to get samples. So, I dont really suggest it too much. My PDOC knows about this so I am only prescribed the weak form, gabapentin at a measly 1,200mg./day. I still chose that script over the Xanax XR and Klonopin script so that definitely tells you how much I like it.

Also consider looking at T3. And too bad buprenorphine couldn't be an option for TRD...

Try this out:

Nardil 75mg.
Geodon 160mg.
Lexapro 20mg.
Lithobid 1,200mg.
Cabergoline 2mg.
Pindolol 7.5mg.
Surmontil 100mg.




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