Posted by SLS on July 8, 2000, at 14:30:48
In reply to Re: And how was the lamictal alone scott, posted by AndrewB on July 8, 2000, at 13:12:48
Dear Andrew,
THANKS !!!
I guess it is time for me to look into NMDA and sigma receptors. I'm not really sure where to begin. Any suggestions?
> Have you received any mood improvement from lamotrigine?
Yes, but it is minimal. However, since it is steady, I remain on it and hope it will help augment antidepressants. The first time I tried Lamictal, I had just discontinued a combination of Nardil and desipramine. Within 2 weeks at 25mg, I thought my quest had ended and my life begun. I felt about 50% well. Enough for me to go back to work and chase girls. Unfortunately, the antidepressant effect plateaued and then fell-off. In retrospect, I realize that the Lamictal had actually worked synergistically with the improvement rebound I often experience when I discontinue either Nardil or a tricyclic. Man, I thought that was it.
I don't know to what degree Lamictal works as an antidepressant in unipolar or dysthymic presentations, but it is often sufficient monotherapeutically for treating bipolar depression. Are you thinking of trying it? I think it might have some indirect pro-dopaminergic effects. My guess. One of the facts that has me thinking this way is that it is so apt to produce nausea, which is why I also think Effexor may produce greater pro-dopaminergic activity than is recognized. I have a few other reasons as well.
> So the sulpiride is just making you sleepy. If it doesn't work, whats next? Mirapex?
Well, I decided to raise the dosage to 150mg a day as of yesterday. The "cruddiness" seems to have disappeared for the moment. I don't feel anything positive at this point, but I will give it a bit more time. I have no reason to be optimistic. I'll let you know about all of the details as they occur.
As to what to do next, I really don't know. I will probably play with Provigil to see what it does, either with or without sulpiride. I think I will leave DA agonists and naltrexone for combining with an MAO inhibitor.
I am facing a decision as to whether or not to see a new doctor before continuing. Parnate is the next proposed step, but it might make sense to get another opinion before proceeding.
> Glutamate and NMDA receptors (which respond to glutamate) have been implicated in depression. Some drugs that I have been gathering info. on lately are memantine, nimodipine and ketamine (low dose nasal spray or eye drops). These are either direct or indirect NMDA receptor antagonists. Recent studies have shown antidepressant efficacy for ketamine and nimodipine. It is reported that memantine and nimodipine work synergistically together. Ketamine's AD effect is increased when combined with lamotrigine. Just something for you to look into.
Where do you find this stuff? I could use some additional resources. I am not familiar with ketamine or memantine. What do they do? Are they available in the U.S.? What research has been done specifically regarding depression?
Does nimodipine do things other than block L-type calcium channels? I saw one person report success with it on the board before it turned over. I don't recall what his/her diagnosis was. Expensive stuff. I think its only indication is for post-stroke application to help prevent necrosis.
> I know you have been looking farther afield for treatment options lately.
Yes, although I am still a bit hesitant to think beyond mainstream. Do you think that either hypericum or sAME are effective in cases of *severe* depression? I pray that I will be patient enough to try different things before reaching backwards for Parnate et al.
Thanks again.
Sincerely,
Scott
poster:SLS
thread:39627
URL: http://www.dr-bob.org/babble/20000708/msgs/39813.html