Posted by ben on November 8, 2001, at 13:26:06
In reply to Re: Refractary bipolar depression To Scott !!! » petters, posted by SLS on November 8, 2001, at 10:32:27
> > Hi Scott...
>
> Hi Petters.
>
> > I forgott mention, that I also saw an artikel from DR. I Goldberg. He paid attantion to when Lamictal not was sufficient in bipolar depression. He recommend Topomax as an add on strategi. Since I know your only mood stabilizar are Lamictal if I don´t remember wrong.
>
> You remember correctly. Topomax was the first anticonvulsant my doctor mentioned if we are to add another mood stabilizer. I guess he must have heard good things about it from his colleagues at NYU (New York University). I am excited by what you say about the Lamictal + Topomax combination. I am worried about the cognitive side effects, though (slow-thinking, memory).
>
> If you don’t mind my asking, how do you know so much about psychiatry? Your observations and suggestions are very astute and intelligent. I very, VERY much appreciate your contributions.
>
> > By the way: Have you tried Flupenthixol in low dosage.
>
> There are four “typical” neuroleptics that are candidates that I would consider. Flupenthixol is one of them. The other three are molindone, sulpiride, and amisulpride. Molindone is available in the US. Sulpiride and amisulpride are not, but I can get them from England. I currently have enough sulpiride to conduct a trial. A Dr. Levine in New York who specializes in TRD (Treatment Resistant Depression) prefers to use sulpiride. In his words, he says that amisulpride is too much of an antipsychotic.
>
> > Or do you have Etilefrinhydoklorid in U.S? It´s a med for hypotension, but in low dosage it´s benefit for some depressed person, especeliy with astenia, and anergia as I know you sometimes suffer from.
>
> I never heard of this drug. Is it a ACE inhibitor (Angiotensin Converting Enzyme inhibitor)? There is some evidence that captopril (Capoten), an ACE inhibitor, has some antidepressant properties.
>
> > Stay Well...
>
> You too.
>
>
> - Scott
Hi pettersFor your information Etilefrinhydrochlorid (trademark: Effortil) is a so called sympathomimetic. It stimulates alpha 1 and a little bit alpha/beta 2 receptors. It is very similar to the neuroendocrine transmitters noradrenaline and adrenaline.
I wouldnt try it as an AD because it can make high blood pressure (hypotension is the real indication) and people often develop tolerance to it. It could be a try worth if you have hypotension and dont take others AD in combination (dangers interactions are possible). Did you tried d-amphetamine (Dexedrine) or methylphenidate (Ritalin) to overcome your astenia ? And some possible targets: Checked your thyroid hormones ? Iron status ? Vitamine B12 ?
Discuss this issues with your doc.Good luck
Ben
poster:ben
thread:83508
URL: http://www.dr-bob.org/babble/20011104/msgs/83559.html