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Medication Management: Episode 2

Posted by smart.drug on May 13, 2008, at 3:58:59

Hey everyone,

Welcome to another episode of Medication Management, where you can help me out with my meds. Today, we're discussing core symtoms of dysthymia.

So basically, I have dysthymia with recurrent MDD. The problem is, when I go to my school pdoc, he's like, "You don't fit the criteria for dysthymia." No, I don't! 'Cause I'm "fine" when there's no stress. But I don't want to wait for the next episode of depression. If medication can help to prevent it, I'm all for it.

I think there are three basic things that I ought to do in any case. One is exercise--for obvious reasons, too numerous to list. Two, omega-3 (from fish, not flax.) Again, too many benefits, not very many side-effects. Okay, third thing is Deplin (methylfolate.) It's approved as an antidepressant augmentor, so maybe with the other two measures, it can be enough to prevent an episode of MDD, In any case, I doubt it can hurt. It probably impacts "core symptoms," without being sedating or stimulating, so it's fine with me.

Okay, moving onto meds. I have a few options in mind. Help me pick one, or just give me your feedback.

1.) Okay, we'll start with the simplest one. An SSRI with bupropion (or methylphenidate/ Adderall.) Pros: it's simple. Cons: The stimulants can make me lose sleep. I tried Lexapro, which gave me bad diarrhea and cramps. I hung tough for six weeks, but it never got any better. I give that other SSRI's have different profiles, but they scare me.

2.) Import reboxetine and tianeptine, and get my doc to prescribe selegiline 5 mg bid. Pros: I'm hitting all three neurotrasmitters, so the best chance of success. Cons: Money. I'm going to have to pay for the first two out of pocket. Also, my hope is that by hitting all three, I can avoid side-effects (brain lowers dopamine in response to SSRIs). But I might get a whole bunch!

3.) Selegiline 5 mg bid, DLPA, lithium 1 cap hs, and buspirone. Okay, this one looks crazy, so some explanations are in order. The selegiline is in the MAO-B selective range, so I can crank up the dopamine, while avoiding the tyramine reaction. D-Phenylalanine is converted to PEA, which selegiline can prevent from being destroyed. PEA is a stimulant antidepressant in its own right (when taken with selegiline.) The LPA will just be converted to dopamine, so I guess it won't hurt. To avoid an imbalance, I'm using the buspirone and lithium to increase serotogenic activity without getting into an SSRI. Some people get scared when they even look at the word lithium, but I doubt that at a dose that low (300 mg at bedtime), I'd see any side-effects. Also, lithium is used an an antidepressant augmentor in its own right. Of course, I'd do all the blood work and stuff.
Pros: sounds good. Cons: dunno if it'll work! And complicated, too.

4.) Go for broke. Use 30 mg or more of selegiline, in the unselective dose range! Pros: No doubt it'll work! Cons: dietary restrictions, and won't be able to use stimulants if I need them.

The thought of EMSAM has crossed my mind, but my insurance benefits are limited; I can't afford it. I'm waiting for lastodigil to come out!

Anyway, I'm tired of having this dark cloud hang over me all the time. I'm ready to do something, and I'll make my doc listen! And I appreciate your help!


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