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Re: What to combine with a mood stabilizer? » tensor

Posted by Ritch on December 28, 2004, at 18:37:31

In reply to Re: What to combine with a mood stabilizer? » Ritch, posted by tensor on December 28, 2004, at 15:03:57

> It seems that none of them is effective, i've been on remeron for a long time and the add on of zoloft last spring made me recover from that relapse. So it's hard to say which is least effecient.

> >Then try just lithium (or lamictal) by itself and see what happens.
>
> I think my doctor would disagree with this, for depression, isn't lithium used as an augmentor to an AD?
>
> >Then consider the nortriptyline. I suggest withdrawing from the ineffective drugs first, so that taking them doesn't cloud your response to the mood stabilizer and so that you don't make too many changes at the same time that will muddy the waters also.
>
> Yes i agree, must give each combo a fair trial, but it's taking so much time. Would really need an antidepressant fast. Have you any experience of nortrip?
>
> Kind regards,
> Mattias
>
>

Aha!, So the Remeron by itself wasn't doing much and you added Zoloft and got some improvement. I would suggest leaving in the Zoloft and ditching the Remeron, wait a little bit for it to wash out (2 weeks or so), THEN add the nortriptyline to the Zoloft, mess with lithium or whatever later on after you'be been on Zoloft+nortriptyline for a while. Get blood levels done on the nortriptyline. The Zoloft will boost it-you need to make sure not to let it (nortriptyline plasma levels) get too high. Your pdoc will know the "window" that you need to be in. I think that's your best bet... drop the Remeron, add the nortriptyline to the Zoloft, get the dose right (of the nt) and see what happens. Lithium by itself would probably not be a good idea for a unipolar depressive (I thought you were bipolar-sorry about that). Yes, I've had experience with nortriptyline. Easiest to tolerate TCA I've taken. The only one that didn't give me orthostatic hypotension (dizziness standing up suddenly). In fact... combined with Zoloft (in particular), it worked rather well. Hope this helps some.


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poster:Ritch thread:434951
URL: http://www.dr-bob.org/babble/20041228/msgs/435158.html