Posted by dove on December 13, 2004, at 9:33:20
In reply to Re: Time to act, at last... ?, posted by Nagash on December 11, 2004, at 7:05:10
While Mianserin (Lerivon/Bolvidon) helped with your anxiety and sleep problems, did it agitate your Restless Legs Syndrome? If not, then my first recommendation is to try Remeron (generic-mirtazapine) before bed. At lower doses it is more sleep enhancing, at higher doses (45 mgs.) it is more activating and has more norepinephrine releasing properties (while still being a great sleep enhancer). Combine with Reboxetine or a more activating TCA (Nortriptyline, desipramine).
How much amphetamine are you taking daily? And are you ingesting it (rather than "tweaking" or "spinning")? There are some strategies for lowering tolerance and getting the most out of amphetamine's synergies. Be aware that amphetamine can cause a worsening of depression as well as complicating its treatment (in addition to causing ambivalence to pleasurable activates at higher doses.).
Cymbalta's generic name is duloxetine, a dual reuptake inhibitor, and definitely worth looking into.
Personally, I would try a combo of an activating AD, whether a TCA, SSRI, or SNRI with Remeron (mirtazapine) or Mianserin (Lerivon/Bolvidon). If I was going the Wellbutrin (bupropion) route, I would try that alone for a few weeks before adding anything else. I would also add a CNS stimulant to the first combo, but in small amounts and after a few weeks in order to adjust properly.
I am currently on Effexor 225 mg, Prozac 20 mg, Adderall 40 mg (20, 10, 10), Remeron 45 mg (before bed) with 2 mg of sublingual Melatonin. I have also taken klonopin with this combo for panic attacks and severe anxiety but haven't needed it at all for many (5) months.
One other med I still think is worth looking at is the MAOI Parnate, although it has some food and med interactions that would need to be taken seriously. Parnate and Cymbalta (duloxetine) are the two meds I have in mind should my combo begin to fail. However, I suffer from severe major depression. Lexapro might be something to consider, especially in combo with mirtazapine or mianserin.
just some thoughts...
dove
poster:dove
thread:399975
URL: http://www.dr-bob.org/babble/20041211/msgs/428831.html