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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by cadett on October 20, 2014, at 0:40:58
Taking 60mg. of cymbalta 150mg. of provigil and alprazolam for sleep. Doing much better but still having a lot of down days. What would you add to this to get over the hump?
Thank you in advance.
Posted by Christ_empowered on October 20, 2014, at 1:19:20
In reply to need just a bit more, posted by cadett on October 20, 2014, at 0:40:58
I dunno...what are you trying to improve? My first wild *ss guess was some xanax xr during the day. Then I thought...up the Provigil or go for Ritalin or Focalin.
Posted by SLS on October 20, 2014, at 3:26:36
In reply to need just a bit more, posted by cadett on October 20, 2014, at 0:40:58
> Taking 60mg. of cymbalta 150mg. of provigil and alprazolam for sleep. Doing much better but still having a lot of down days. What would you add to this to get over the hump?
> Thank you in advance.Psychotherapy?
You can go higher with the dosage of Cymbalta or substitute it with Pristiq. With either of these drugs, you might add Wellbutrin or Abilify.
- Scott
Posted by Christ_empowered on October 20, 2014, at 7:25:43
In reply to Re: need just a bit more » cadett, posted by SLS on October 20, 2014, at 3:26:36
Have you heard of "california rocket fuel" ? Its Effoxer XR+Remeron, I think usually both at full doses. Surprise, surprise; there's a new-ish remake using Cymbalta instead of Effexor.
The only abstract I could find on the combo said it helps, but can cause "changes in mental state," which apparently includes (hypo)mania.
I just skimmed over the little abstract. I've heard that 30mgs/day Remeron causes less dense sedation and weight gain than the lower doses (I wanna say you can go up to 60mgs/day).
Remeron is generic, so acquisition costs are minimal. The combo could cause serotonin syndrome. The Effexor xr+ Remeron combo compared favorably to Parnate (similar results, more tolerable, no dietary restrictions) in some big study, probably one of the end stages of STAR D. If I recall correctly, the sample size was really small, so...the data isn't great. And that's Effexor xr+remeron, not cymbalta+Remeron, so...
...just a thought :-) I'd be kinda sorta concerned about night time Remeron plus xanax, just because...well...over-sedation is probably not what you're aiming for. Also, if (hypo)manic activation occurs, you've got nothing in the combo to help you simmer down.
Other thoughts....very low dose zyprexa, buspar, abilify (thank you, SLS), seroquel (maybe xr, if you have good insurance) at low-ish dose....lamictal...
...I have no idea what your remaining problems are, of course. Since you're getting reasonably good, but obviously sub-optimal results, now might be a good time to make a list of what you want/need out of treatment.Some symptoms are very treatable with Rx drugs. Others might be better dealt with through therapy, exercise, better sleep hygiene, maybe even supplements/complementary medicine, if you're into that sort of thing.
Hope this helps.
Posted by SLS on October 20, 2014, at 9:18:00
In reply to Re: need just a bit more, posted by Christ_empowered on October 20, 2014, at 7:25:43
> (thank you, SLS)
I would like to thank you, too. Your contributions here are accurate, creative, intelligent, and kind. You really know your stuff, and I like to steal your ideas for myself.
:-)
I would just add that Remeron is more likely to produce a robust antidepressant effect at dosages of 45 - 75 mg/day. Some people go to 90 mg/day. As you mentioned, sedation and weight gain often subside at higher dosages. Believe it or not, the neuroleptic antipsychotic, lurasidone (Latuda), like Remeron, is a potent antagonist at NE alpha-2 receptors. Along with that is is an agonist of 5-HT7 receptors and a partial agonist at 5-HT1a receptors, Latuda looks good on paper to treat depression. I haven't seen it work for anyone yet. Too few people have tried it. It is not approved for bipolar mania, believe it or not. The drug company has not yet presented clinical data to the FDA, but they plan to do so.
- Scott
Posted by Christ_empowered on October 20, 2014, at 9:33:30
In reply to Re: need just a bit more, posted by SLS on October 20, 2014, at 9:18:00
I do my best....thing is, I don't understand neurotransmitters and such, except at a really elementary levels. Weirdly enough, a lot of my knowledge base comes from my anti-psychiatry phase. Anti-psychiatry stuff, especially of the more intellectual sort, often makes heavy use of the old literature (check out "Mad in America" , for instance).
Plus, I've taken lots of pills--fun, not fun, effective, ineffective, prescribed, not legally prescribed--so I guess, now that I'm "in recovery" (as much from my own personal sins and mistakes as from madness), I figure I'll put pill popping knowledge to reasonably good use, lol.
Posted by Phillipa on October 20, 2014, at 9:36:42
In reply to Re: need just a bit more, posted by Christ_empowered on October 20, 2014, at 9:33:30
Changing subject are you doing the online classes? Phillipa
Posted by Christ_empowered on October 20, 2014, at 9:43:15
In reply to Re: need just a bit more » Christ_empowered, posted by Phillipa on October 20, 2014, at 9:36:42
yeah, I am doing online classes. This is my 3rd sub term (they divide normal semesters into 2 sub-terms). I'm doing well and really enjoying it.
Thanks for asking :-)
Posted by SLS on October 20, 2014, at 9:49:53
In reply to Re: need just a bit more, posted by Christ_empowered on October 20, 2014, at 9:33:30
> I do my best....thing is, I don't understand neurotransmitters and such, except at a really elementary levels. Weirdly enough, a lot of my knowledge base comes from my anti-psychiatry phase. Anti-psychiatry stuff, especially of the more intellectual sort, often makes heavy use of the old literature (check out "Mad in America" , for instance).
>
> Plus, I've taken lots of pills--fun, not fun, effective, ineffective, prescribed, not legally prescribed--so I guess, now that I'm "in recovery" (as much from my own personal sins and mistakes as from madness), I figure I'll put pill popping knowledge to reasonably good use, lol.Your anecdotal reports are invaluable. Thing on paper don't always translate to clinical reality.
- Scott
Posted by SLS on October 20, 2014, at 9:58:37
In reply to Re: need just a bit more, posted by SLS on October 20, 2014, at 9:18:00
Oops.
"[lurasidone] is an agonist of 5-HT7 receptors"
Sorry for the error.
Corrected:
[lurasidone] is an *antagonist* of 5-HT7 receptors
- Scott
Posted by cadett on October 20, 2014, at 11:43:05
In reply to Re: need just a bit more, posted by Christ_empowered on October 20, 2014, at 9:33:30
Thank you everyone for your insight and suggestions. This site has been a great help to me in the last 3 years. I don't post much but read everyday.
Posted by phidippus on October 20, 2014, at 21:43:05
In reply to need just a bit more, posted by cadett on October 20, 2014, at 0:40:58
You're taking a median dose of Cymbalta. I'd bump that up to 120 mg.
Eric
This is the end of the thread.
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