Posted by JohnL on March 16, 2000, at 2:44:07
In reply to Me and My Thyroid , posted by Noa on March 13, 2000, at 17:55:29
I agree totally with Cam. When combinations work it is terrific. But when they don't it becomes more complicated to make wholesale changes. I think a good place to start is to face the fact that you are still meeting qualifications for major depression. A different approach in medication is warranted.
In your shoes I would drop dosage of all the meds, except in varying degrees with each. I would drop the Lithium to 1200mg and keep it there. I would drop the Effexor in small steps every four days or so. I would drop the Serzone too, but a little less so than the Effexor. If nothing else, you want to retain a good night's sleep through it all.
You might get lucky and find you feel a lot better at a lower dosage schedule. More is not always better.
I would also consider trying a med from a class not yet tried. A top choice would be an antipsychotic. There could very well be a dopamine component in the apathy, and these will address that. Zyprexa is good for sleep. Stelazine for some alterness (this is similar to Amisulpride). Risperdal is somewhere inbetween. I mention this simply because other med classes have been disappointing. It is definitely worth exploring other chemistries at this stage of the game. Usually when an AP is going to work, it is obvious in days. They typically don't require the long wait of antidepressants. If it is to work you'll know without a doubt within two weeks.
Another great choice would be Desipramine or Nortriptyline. There is a test that is sometimes predictive....a positive effect of Ritalin on mood predicts a good response to Desipramine....the absence of a good effect of Ritalin on mood predicts a good response to Nortriptyline. In either case, I think one of these tricyclics should be tried and compared.
In your shoes I wouldn't wait to be totally off the other drugs before adding in a new one. If the antipsychotic is to work, you'll know. Then continue the taper down process while allowing the AP to take the wheel. Same with a tricyclic. There's no easy way here, but these are things I would do myself. I am not suggesting these things directly, but sharing with you what I would do myself in the same situation. I would look at unexplored drug classes. And I would definitely take the ones that aren't getting me better out of the program. They're obviously targeting the wrong chemistry. They aren't the molecules our chemistry agrees with. JohnL
poster:JohnL
thread:26901
URL: http://www.dr-bob.org/babble/20000312/msgs/27171.html