Posted by A0102 on February 3, 2002, at 6:27:14
In reply to Re: Looking for advice for TRD / anergia, posted by Elizabeth on February 2, 2002, at 12:18:35
Elizabeth,
Thanks for the advice! I'll give a little more insight now, but I didn't want to make my post but SO long. I am currently taking 75mg of Effexor XR daily. This is my 2nd week on it and I am increasing to 150mg next week. After that I have an appointment with my pdoc to decide where to go from there.I thought Dexedrine sounded like a good idea because of it's obvious "getting me out of bed" properties, but for other reasons as well. I have tried Adderall before (only 10mg) and found that it worked quite well at helping me find interest in life in general. It also helped me to focus on my school work much better. I'm not trying to say that I could be ADD but I noticed that I did spend much more time paying attention to what the professors were saying instead of daydreaming. I also found that it did almost nothing in the way of being physically stimulting. As odd as it seems, I found it calming in a way. You can see that I tried Provigil before to augment several of the other ADs, but it was pretty much worthless for me. I could take 400mg and still sleep 14 hours. Anyway, the 10mg of regular Adderall seemed to do well but I would prefer an all day dose. Would 20mg of Adderall XR or 15mg Dexedrine Spansules not provide similar action? (I don't know, I don't have too much experience here.)
I also wanted to add Remeron to insure that I don't have trouble falling asleep after taking a stimulant. I do take Sonata on occasion because a lot of the time I keep myself from going to sleep trying to figure out how to catch up on what I've missed during the day. My concern with continuing to take Sonata along with a stimulant is relying on them to regulate my sleep cycle and eventually building myself up to a crash. Also, Remeron works very well to increase my appetite which is another concern I have with stimulants.
I have not tried an MAOI yet due to the fact that my pdoc says I would likely have migraines with them similar to my experience with Wellbutrin. I'm not sure exactly how he came up with that or why he decided to go with Effexor. Effexor has a 25% rate of occurance of headache! Nonetheless, I am taking it now and don't really want to try to stop before I've given it a chance, as well as the withdrawl symptoms and my pdoc getting pissed for noncompliance.
So, that is where I stand right now. I'm hoping I won't have another post here in a few weeks asking for recommendations on a new pdoc. This one seems to be caught up in running through the list of every commonly used med before trying anything creative to target my specific symptoms. I'm not sure if that's good(i.e., patience) or bad(i.e., incompetence), but all I know is that while he's busy with that I'm dropping out of classes and losing my job.
Anyway, sorry for rambling on and thanks again Elizabeth and anyone else who wants to contribute!
Adam
> 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:A0102
thread:92489
URL: http://www.dr-bob.org/babble/20020131/msgs/92693.html