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Re: Mood stabiliser + antipsychotic for depression NKP

Posted by SLS on January 4, 2023, at 20:30:57

In reply to Re: Mood stabiliser + antipsychotic for depression, posted by NKP on December 3, 2022, at 4:47:39

> Currently I'm on venlafaxine 225 mg/day and lamotrigine 200 mg/day. This combination works well except for the following side-effects: (i) excessive sweating; (ii) no sexual desire; (iii) apathy and lack of motivation. I think that venlafaxine is the culprit.
> I'm seeing my psychiatrist on Wednesday. I want to propose a few alternative combinations to him. Any ideas will be appreciated.
> (i) sertraline 50 mg/day + flupentixol 0.5 mg/day
> (ii) sertraline 50 mg/day + lamotrigine 200 mg/day
> (iii) flupentixol 0.5 mg/day + lamotrigine 200 mg/day
> (iv) duloxetine 20 mg/day + flupentixol 0.5 mg/day
> (v) duloxetine 20 mg/day + lamotrigine 200 mg/day

The side effects you are concerned about certainly sound like those of a serotonin reuptake inhibitor. I know nothing about flupentixol. Is it capable of producing the side effects you are experiencing?

A few hopefully helpful comments:

1. I do not respond to Effexor at 225 mg/day. 300 mg/day gives me a partial improvement. Drug companies look for that sweet spot and chooses as its maximum dosage one that produces robust efficacy, but with a minimum in the number or magnitude of side effects. They try to minimize the number of drop-outs. Sometimes, they become their own worst enemies. I don't have statistics to cite, but they are out there. I think that there are too many people who fail to respond to 225 mg/day and go on to respond to 300 mg/day not to make 300 mg/day the maximum dosage recommended by the drug company. I would be surprised if someone who tolerates 225 mg/day could not tolerate 300 mg/day. I see recent papers reporting the use of 300-375 mg/day of Effexor for treatment-resistant or severe cases. During the dosage finding phase of their R & D of Effexor, I think 600 mg/day was one of the dosages evaluated. Some doctors are not afraid to use 600 mg/day.

2. Many people need 300 mg/day of lamortrigine to get the most antidepressant effect from it. In my experience, lamotrigine does *not* produce an all-or-nothing drug response. In other words, one can experience a partial improvement at 200 mg/day, and a much greater improvement at 300 mg/day.

3. Sertraline can be given at a maximum dosage of 200 mg/day. Why would you limit yourself to 50 mg/day?

4. Duloxetine can be given at a maxiumum dosage of 120 mg/day. Why would you limit yourself to 20 mg/day?

5. Do you place a limit on the number of drugs you take at the same time?

* If you have developed a hypersensitivity to the side effects of SRIs at low dosages, that doesn't imply that you need low dosages to respond.

Good luck.

- 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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