Posted by Elizabeth on September 12, 2001, at 5:29:47
In reply to Doc's Experience with Zyprexa, Lamictal, more., posted by JohnL on September 9, 2001, at 7:21:25
> Dr. Fawver: Depakote would be no problem. Lamictal I wouldn't combine with a monoamine oxidase inhibitor because
> Lamictal does have a selective serotonin reuptake inhibitor built into it.(This is a confusing way of saying that Lamictal is a serotonin reuptake inhibitor, right?)
FWIW, I took Lamictal, up to 500 mg/day, with Nardil for several months without problems.
> Q: Is Lamictal an effective antidepressant?
I didn't get any AD effect out of it. Actually I didn't notice any effect, period.
> Q: Does double depression exist?
>
> Dr. Fawver: I think it does. Double depression is major depression with dysthymic disorder. These people have been
> depressed since they were kids.That could be me (that, or subsyndromal ADD).
> Even when they get well, they don't seem to all the way recover from the major depression.
This is definitely me, since the onset of major depression (in childhood, around age 10). Depression changed me irreversibly.
> We're getting a lot of benefit from using the atypical antipsychotic medications for augmentation for unipolar depression.
This is true -- atypical antipsychotics seem to help some people, at least in low doses -- but they also often make depressives feel worse rather than better. Also, 10 mg seems a bit high for people with nonpsychotic depression. I would probably want to start at 2.5, the lowest available pill size.
> Dr. Fawver: Depression is schizoaffective disorder, the antidepressants certainly do play a role.
I think that should be "depression IN schizoaffective disorder..." ?
> With depression in-patients with schizophrenia, 80% of patients with schizophrenia have a clinically significant degree of
> depression at some time in their lives.Especially following major psychotic episodes.
> If you're using the older antipsychotics -- Haldol, Stelazine,
> Prolixin. They cause depression.They do. But the newer ones often do too. The newer ones, though, can help with negative symptoms and do seem to carry less risk of EPS.
> Depression in borderline personality disorder. It's always there with these borderline patients, and antidepressants can help to
> some degree, but again, I'm using a lot of atypicals with my patients with borderline personality disorder.Note: tricyclics should not be used in BPD. They can potentially make it worse.
Re part-time ADs for PMDD:
> You can use Prozac, 20 mgs a day or Zoloft, 50 mgs a day. They tend to do very well with that.I know a woman who used Paxil for this, to good effect. Luvox and Celexa are probably effective too. It doesn't work for women with irregular periods, for obvious reasons.
> If any of us in this room right now took 20 mgs of Prozac, in about 20 to 30
> minutes our serotonin levels in our brain would increase.This is important in that it shows that "serotonin deficiency" is not a cause of clinical depression simply because serotonergic drugs often relieve depression.
Re depression in old age:
> I will often combine
> a small amount of these newer medications for depression with just a pinch of Ritalin or Dexedrine, and it will perk them up very
> nicely, especially if they've given up on life, especially if they're medically ill, ...Yes, stimulants can be of great help to people who have "given up" or who feel resigned. I've been trying to get a friend who is like that to get some stimulants.
BTW, I think that some of the weight gain from antipsychotics such as Zyprexa can be traced to lethargy and sluggishness.
> Seriously, the weight gain thing bothers me greatly. I like to grow rose plants. One thing I've noticed is that the most beautiful and the most aromatic ones are also the ones with the nastiest thorns. I guess Zyprexa is kind of like that.
I think that's certainly true of buprenorphine. The side effects can be very hard to tolerate, and you have to be really motivated to get will if you're going to be able to put in the extra effort it takes to manage them.
-elizabeth
poster:Elizabeth
thread:78359
URL: http://www.dr-bob.org/babble/20010907/msgs/78636.html