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My frustration in watching you. I apologize. linkadge

Posted by SLS on November 30, 2022, at 8:05:38

In reply to Saw doctor today, posted by linkadge on November 29, 2022, at 15:58:04

> We decided to go on the past combination that seemed to work best.
>
> - venlafaxine 37.5
> - mirtazapine 7.5mg
> - lithium 300mg
> - ritalin 10mg
>
> Wellbutin was doing something, but it wasn't nearly as grounding as ritalin.
>
> Linkadge


Most of my angry words towards and about you were actually an expression of great frustration - frustrations about seeing you continue down a path of accepting merely palliative relief.

I renew my suggestion for your staying away from SRIs for 3 months. I *think* the dynamics of your serotoninergic system(s) have become overly sensitive due to an unending course of on/off/on exposure to SRIs. This includes non-response and acute side-effects.

From what you have written recently, I suggest that at a point in the not-too-distant future, you begin attacking your illness with things that you have NOT tried yet. In my opinion, my limited knowledge of your treatment behavior has you running around in circles.

To me, the most obvious selection of drugs at this point are a combination of:

1. Nortriptyline
- respect the existence of two distinct effective dosage ranges - each forming a therapeutic window.
- low dosage range: 25-75 mg/day
- high dosage range: 100-150 mg/day
- use blood tests of nortriptyline blood levels in order to determine which range to remain at.
- if you respond to nortriptyline as robustly now as you did before (75% improvement), leave it in place indefinitely and build a regime around it. Just keep on taking it unless contraindicated with a new treatment choice, or side effects become intolerable. Give the side effects that emerge with each dosage increase time to recede before increasing the dosage again. You might want to wait until 2-3 weeks have passed after the side effects mitigate. Perhaps you can gage your titration rate according to a

2. Lithium - Continue low dosaage at 300 mg/day.

3. Wellbutrin SR or XL - 300 mg/day

4. Palliative treatments that are not contraindicated and that you know gives you enough relief that it will allow you to continue trialing different treatment regimes. (Ritalin, etc.)

5. Anything else you can think of that targets *remission* rather than a palliative dead-end. The key might be to *design* treatments around drugs that helped you in the past that might work synergistically rather than additively. Which other treatments have helped, regardless of magnitude or brevity? Make a list of treatments you have tried to give you some framework around which to choose drugs that help and avoid drugs that hurt.

Perhaps this approach will be of little value to you in your pursuit of a truly robust improvement. However, I do not think it a waste of time to try a very different and logical strategy to attack your illness. At the very least, use logic to determine which treatment regimes to avoid for lack of efficacy or for producing intolerable side effects.

I do not envy your situation, including your *current* denial of access to putatively effective treatments. It is *paramount*, therefore, that you use your formidable critical thinking to troubleshoot the problem of access. You would be surprised by what you can accomplish for free using a the phone or email. You have an obstacle. Figure out ways to surmount it. I think is a better use of your time right now to do the legwork and figure out how to get drugs that are novel to your brain (Nardil, for example) rather than cycling endlessly between failed treatments. Look for a university research program that will treat you *inpatient*. Allow the clinical researchers navigate your treatment and observe the results. This includes different treatment regimes - including new ways to use old drugs, including those you had "failed" on. You might also have access to novel compounds in the approval process. If you respond, the research program will likely supply you with a drug until it is approved and becomes available.

Experts will determine what is to be defined as treatment "failure" and treatment "success" - not you. Give research doctors the opportunity treat your challenging case. That's what they do for a living.

The cool part of doing this is that it's FREE. It will cost you only the funds necessary for transportation.


- 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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Psycho-Babble Medication | Framed

poster:SLS thread:1121154
URL: http://www.dr-bob.org/babble/20220917/msgs/1121159.html