Posted by Elizabeth on February 2, 2002, at 12:18:35
In reply to Looking for advice for TRD / anergia (long), posted by A0102 on February 1, 2002, at 5:08:57
Hi. Sounds like you have the fairly common problem of SSRI-induced apathy as well as residual anergia that ADs haven't been helping with.
The idea of adding a stimulant sounds good. The Remeron might make the drowsiness worse -- at low doses it can be very sedating. You might want to add the Dexedrine alone and wait and see if you have insomnia problems from the Dexedrine or if the Effexor causes side effects that Remeron might alleviate. In general it's a good idea not to add medications until you know how the one you're taking is working, or to start multiple drugs at a time.
I don't think that addiction is a serious concern with Dexedrine, as long as you don't abuse it. If you find yourself wanting to take more than the amount prescribed, you should tell your doctor.
I notice that MAOIs (Nardil, Parnate, Marplan) aren't on your list, although you've tried several tricyclics. I think they're worth a try for someone like you (nonresponse to TCAs, apathy on SSRIs). Parnate is the one I'd recommend, as it tends to be the most stimulating (although it isn't always). If you're scared of the dietary restrictions or the risk of hypertensive crisis, that stuff has really been blown out of proportion -- there are very few foods that you actually need to avoid. Of course, you can't take MAOIs with most other ADs, and I think the Effexor/Dexedrine combination is worth trying (you should see how Effexor works by itself before adding Dexedrine, of course). But it might be a good next step if this doesn't work for you.
How much Effexor are you taking? Effexor isn't a SSRI (it's a norepinephrine reuptake inhibitor too, so it's not considered "selective") and it can often work for people who haven't found the SSRIs very helpful. I'm taking 225 mg/day, and it seems to be helping. My pdoc and I are planning on going up to 300 mg or more.
I hope this helps. Good luck with the Effexor. Oh, and welcome to Psycho-Babble!
-elizabeth
P.S. Your post isn't that long -- I've seen some *really* long ones on this board. So don't worry about it. :-)
poster:Elizabeth
thread:92489
URL: http://www.dr-bob.org/babble/20020131/msgs/92608.html