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Re: remission )) Thank you Jay!

Posted by SLS on September 22, 2022, at 21:39:38

In reply to Re: remission )) Thank you Jay! SLS, posted by Roslynn on September 22, 2022, at 19:23:57

> Hi Scott,
>
> Thanks for your note.
>
> On Abilify 2.5 mg, I became very irritable and wanted to spend more than usual. I stopped that med pretty quickly.
>
> > Did you feel any improvement in depression at all?
> >
> I don't think it made me feel any better.


I don't think akathisia as a side effect of Abilify disappears on its own very often. You did the right thing.

As far as Nardil is concerned, it always made me very dizzy and gave me problems with micturition (initiating urination). I must have tried Nardil ten times or so in 40 years. Without fail, the dizziness emerged and remained problematic. This time, I decided to play a hunch. I thought that if I didn't trigger these side effects in the first place, I might prevent them from emerging at all. I started at 7.5 mg/day (1/2 pill) for a week before going to 15 mg/day. I think I increased the dosage every two weeks by 15 mg/day. At 60 mg/day, you should wait at least three weeks before increasing the dosage again. If 60 mg/day is the right dosage for you, it should show some hint of positive effect by the end of the third week. My guess is that most people respond to Nardil at a dosage of 75 mg/day. I need 90 mg/day. If you tolerate 75 mg/day, you should think about remaining at that dosage for a minimum of 4-6 weeks. If, after 6 weeks, you are tolerating Nardil with respect to side effects, it makes no sense not to go to 90 mg/day.

From what I've learned over the years, the therapeutic dosage ranges are:

1. Nardil - 60-90 mg/day
2. Parnate - 40-80 mg/day
3. Marplan - 40-60 mg/day (I have less experience with this drug).

* For special cases, using "high-dosage" treatment with Parnate can go up to 120-150 mg/day.

I understand that you have problems with blood-pressure spikes with Parnate. With Nardil, if you cannot tolerate a minimum of 60 mg/day for three weeks and no sign of abatement of side effects, the best recourse is probably to discontinue it. Nardil is one of the drugs that I consider crucial to give a long trial if there is any bipolar contribution to your depression.

Regarding Caplyta (lumateperone), drug manufacturers usually have programs to provide expensive drugs to people who are limited financially. I haven't seen anything magical about Latuda for bipolar depression. I'm not really sure that it has a place in treating unipolar depression.
>

Anafranil (clomipramine) is probably the tricyclic that gets the most people well. However, there are people who don't respond to high dosages of Anafranil who respond well to nortriptyline. Regarding nortriptyline, there is a true dosage window. For example:

75 mg/day = no response
150 mg/day = 100% remission
200 mg/day = relapse

Measuring blood levels of nortriptyline can help act as a guide. The accepted therapeutic range is 50-150 ng/ml. From what I've observed, either one is a low-dosage responder (75 mg/day) or a high-dosage responder (150 mg/day). Not many people respond well to 100 mg/day.


- Scott


Some see things as they are and ask why.
I dream of things that never were and ask why not.

The only thing necessary for the triumph of evil is that good men do nothing.

 

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