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Re: Trileptal 600mg » emme

Posted by SLS on June 14, 2005, at 16:38:43

In reply to Re: Trileptal 600mg » SLS, posted by emme on June 13, 2005, at 20:46:13

Hi Emme.


> Hi Scott,
>
> Thanks for your input.

> > Actually, I think it might be worth discontinuing the memantine briefly to see if it isn't the culprit.

> I thought of that, but I don't think my doctor will like that idea b/c it's been so hard to find things that work for my depression.

I was thinking in terms of a few days - even with its long half-life. Being off of it a full week should be plenty of time to see if a trend establishes itself.

> It’s hard for me to believe the microdose I’m taking now is making me a zombie, but anything is possible.

:-)

A little logic here, Emme. This same microdose is capable of exerting a psychotropic effect as an antidepressant - why not also as a cause of other psychotropic effects that are undesirable?

> > I think we had a conversation about this earlier in the year. We both reacted to memantine in the same way the second time around - weakness and fatigue.

> Yeah, you're right, we did. I'm glad one of us has a memory. :)

> > I have not had Lamictal affect me this way - even at 450mg. I just experienced some cognitive impairments.

> When I've been on minimal meds, with mostly lamictal and a benzo, it hasn't killed the depression and I've been tired and apathetic. So maybe Lamictal makes me tired in the long run even though it seemed activating at the outset. Either that or the fatigue is caused by depression.

How much Lamictal are you taking? It is possible that it is causing some flattening of affect that feels like apathy and making you a bit "stupid".

> Anyway, my options for adding antidepressant power aren’t great.

Then how about mood stabilizers?

> My last two tries with Paxil made me terribly irritable or too sedated.

Irritability is not necessarily a bad thing. If it is a startup side effect, it might pass. Irritability also emerges as a sign of improvement of depression.

> Celexa went south after about 6 weeks.

Can you describe the magnitude and scope of your response to Celexa. Did you feel you had reached remission?

> Lex = apathetic and numb beyond belief.

Me too.

> Wellbutrin: 37.5 did nothing. 75 was awfully stimulating.

Stimulation is a good thing, even if it feels uncomfortable in the beginning. How long were you on 75mg before you discontinued it?

> Effexor made me feel sick and increased my pulse hugely, but the dose may have been too high.

Don't worry about pulse. People all too often discontinue TCAs simply because their heart rates increases to 100-120 bpm. This is tragic. This is an expected effect, and a sign that the drug is doing what it is supposed to do, even if only peripherally.

> My pdoc isn’t keen on me having tricyclics around b/c of their lethality in overdose

Awe, poor doctor doesn't want to take the risks necessary to get the patient well. Oh, how I empathize with him - NOT. How often have you attempted suicide?

> (plus higher s/e profiles).

You want to play - you've got to pay. Get tough. The side effects are more nuissances than anything else, and I would much rather have a dry mouth than anorgasmia and apathy. In my mind, the side effect profile of tricyclics are favorable. I like nortriptyline followed by desipramine. If you don't respond to one, you might respond to the other. It happens.

> MAOIs = my dietary habits would make the diet very difficult.

Come on, Emme. Do a little self-talk here. That is a pretty poor reason not to join the life of the living again. Life is waiting for you, Emme. Pay the price and get on with it. You will find that it is a very small one.

> Selegiline = what appeared to me to be cycling. Much better w/o it.

Hmm.

Can you describe in better detail what you experienced?

> SSRIs haven’t panned out for the long term, but maybe try prozac anyway?

Prozac is a drug that makes no sense to neglect. It is different from all the other SSRIs in several ways. It is more noradrenergic and binds to certain 5-HT receptors. However, I would go for nortriptyline or an MAOI first if I were in your situation. You might prefer to start with Nardil because it is less amphetamine-like than Parnate. Even this amphetamine effect is only temporary in my experience. I would not give up before trying both drugs. They are far too different to generalize your experience of one to the others.

> I gotta get less tired and have more spark and initiative.

Parnate?

One nice thing about Parnate is that it is safer than Nardil to add a TCA to it. You can also add Wellbutrin to it. The only true contraindication is a SRI and clomipramine.

Listen, these stimulating drugs that cause complete insomnia are the ones that are going to blow a hole through your wall of treatment-resistance. Just go for it. Treat the insomnia aggressively when it appears. Then just sit back and get well.

I guess I should acknowledge that a drug does not have to be stimulating to make you feel less tired and have more spark and initiative. Anything that attacks the depression effectively will resolve these things, even if it is sedating at first. Nardil is no less apt to treat your anergia than Parnate.

> It's going to hit situation cricital if I don't become more productive.

How so?

> I’m getting more impatient and less and less willing to put up with side effects. And I complain a lot. :)

ME TOO!

It is quite a paradox. The less treatable you are the less treatment you are willing to tolerate.

Get well.

Oh, about me, I decided to stay at 600mg of Trileptal and allow the cognitive stuff to pass. I was encouraged by what a doctor I spoke to yesterday had to say. The "yuckies" should dissipate entirely.


- Scott

 

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poster:SLS thread:511101
URL: http://www.dr-bob.org/babble/20050611/msgs/512683.html