Posted by JohnL on July 25, 2001, at 2:59:26
In reply to Depression / anxiety - any suggestions?, posted by Alex01 on July 24, 2001, at 5:32:08
> Questions I want to ask are: what are some future avenues of investigation? Other meds? Physical cause? Anything else? Any suggestions gratefully received.It always brings me down when I hear that my favorite meds, like Adrafinil or Zyprexa, were not helpful. I hate the saying "mileage varies", but sadly it is so true.
The subtle clues in your post do point to norepinephrine and/or dopamine. The trick is finding just the right chemical molecule to affect those chemistries. I have a hunch that you will likely need the synergistic effects of two meds together, and that no single med alone is going to do the trick.
Zyprexa made you feel dull. I wonder, what dosage was that? And how long were you on it? I ask because I believe the lower doses work best for symptoms like yours. Doses such as 5mg or less. And with Adrafinil, I wonder how long you were on it? For me the benefits accumulated over weeks and months. Though I did feel immediate improvement with either Zyprexa or Adrafinil, I must admit the full effect took time, similar to antidepressants.
Some options to consider: Prozac+Zyprexa. Prozac+Zyprexa+Adrafinil. Prozac+Adrafinil. Risperdal, very low dose (.5mg to 2mg range). Prozac+Risperdal. Even though you may not like the serotonic route, I mention Prozac because it is so different than all the others. It stands alone and in my experience does not resemble the other copycats at all. You may have already tried it. If not, I would consider it.
My favorite suggestion for you though has to be Amisulpride. This is a European antipsychotic that works exclusively on stimulating dopamine D2 receptors. It can work wonders for depression, dysthymia, dullness, anhedonia, anxiety, and social phobias. The only drawback is that it is hard to find. You would have to do some creative online searching with the keywords "Amisulpride" or "Solian" and "farmacia" as well as names of European countries to uncover some possible mailorder sources. They do exist, but it takes some searching and emailing to find them. Your efforts could well be worth it though. This is a wonderful drug.
Another possibility, though lower on my priority list due to side effects, would be the tricyclics Nortriptyline or Desipramine.
And there is also a chance something as simple as 300mg to 600mg of Lithium could work well. I do know of several cases of resistant psychiatric complaints that responded extremely well to Lithium, and very fast. And in these cases, there was no clinical justification at all for trying Lithium. It's just that everything else had already been tried and so there was nothing to lose. It worked miracles and the people wondered why it took so long to come around to it. The reason was of course that there was no clinical justification. However, regardless, it worked wonderfully. Just another option to think about.
I still think your best bet will be some combination of Prozac, Zyprexa, Risperdal, Amisulpride, Adrafinil, or Lithium. Keep in mind that any two of these combined is totally different than the single drug alone. It's like the sum is greater than the parts added together.
John
poster:JohnL
thread:71589
URL: http://www.dr-bob.org/babble/20010720/msgs/71745.html