Posted by JohnL on November 9, 1999, at 3:33:44
In reply to Depressed again, meds, etc. (LONG), posted by Noa on November 8, 1999, at 19:29:58
Hi again Noa. You're not on as many ADs as I thought. The whole mix looks OK to me except the Serzone. I don't know why, but I would question having Serzone in the mix with Effexor. Just a gut feeling. Of all the things that could be combined with Effexor, it seems to me there are much better choices than Serzone.There is no history of TCAs with you. There's something special about those old dirty messy TCAs. They can work magic when the newer stuff doesn't. Either alone or with something else. I agree with you it would be scary and hard to get off the Effexor. I would think it's better to keep working with it.
With that in mind, here are some suggestions. Some heavy hitting pdocs view Effexor+Remeron as 'big guns'. Remeron is also much better for sleep than Serzone. And it won't drug you out in the day like Serzone does. Another possibility I like is adding a TCA. Nortriptyline I like. Desipramine is also a good one. Both have the fewest side effects of TCAs and will aid in sleep. For a more sedating TCA, with wider action to it (less specific) Amitriptyline or Imipramine. TCAs plus SSRIs or Effexor often work real good.
Probably a top choice in a survey of pdocs though is what your pdoc has already mentioned...Lithium. It is probably the first choice option for turning a partial response into a full response. It's dirt cheap and works fairly fast.
So I would talk to your pdoc about two things: 1)Ditch the Serzone and replace with either Remeron or a TCA, 2)Go ahead and add the Lithium, probably in the 600mg range. I have a gut feeling both of those changes will make a world of difference. Hope this helps! :)
poster:JohnL
thread:14839
URL: http://www.dr-bob.org/babble/19991108/msgs/14859.html