Posted by SLS on June 26, 2008, at 5:32:57
In reply to Re: Abilify dosage - too low? » SLS, posted by Bob on June 25, 2008, at 23:58:12
> Scott -
>
> What was your reasoning behind the Nortriptyline, as opposed to something like Remeron or Welbutrin?
>
> What is the rationale for the Lamictal?
>
> - BobIt works. :-)
The beauty and abomination of clinical psychiatry is that there is often no rationale, only trial-and-error experience. I first tried Lamictal as monotherapy in 1993. I experienced what many others do with this drug. I felt improved during week 2 for a few days, and then upon dosage increases. I have developed a "feel" for drugs and how they affect me. I chose 4 of the 5 drugs I currently take, even though I had pry Nardil + nortriptyline out of my doctor.
Yes, one can make educated guesses based upon experience, and even choose drugs based upon mechanisms of action. An educated guess - that's all. I think we are evolving here at Psycho-Babble, such that our educated guesses are becoming relevant.
I had two reasons to choose Lamictal. I received partial relief from it. Secondly, that I guessed so early that it had secondary pro-dopaminergic effects supported my continued use of it. But clinical outcome was, of course, more important.
My first success with treatment came in 1987. I responded well to Parnate + desipramine. Unfortunately, it lasted only 6 months. However, the MAOI + TCA combination remained partially effective before other doctors got a hold of me. I won't cover that lengthy story here, but suffice it to say that their inappropriate use of antidepressants and neuroleptics produced even greater treatment resistance than I had had previously.
I find each of nortriptyline and Nardil to be more anti-anhedonic than desipramine or Parnate.
Both Wellbutrin and Remeron make me very much more depressed. I verified this through trying both drugs several times.
To make a long story short, I have tried to offer here the clinical experiences that I and the many doctors I have seen over the years. I believe that they are more relevant than PB theories.Q: What drugs helped you, regardless of the length of the time spent improved or the magnitude of the response?
Theory?
Ok.
Low-dose Abilify acts to block presynaptic receptors and does not affect postsynaptic receptors to the same degree. In fact, if synaptic levels of dopamine are low, the postsynaptic receptors are actually stimulated by the drug. It is a question of ratios between pre- versus post-synaptic tone. It might make sense to avoid the pro-dopaminergic side effects (nausea, etc.) by starting at a higher dosage to begin with.
Just a layman's educated guess...
- Scott
poster:SLS
thread:836355
URL: http://www.dr-bob.org/babble/20080626/msgs/836518.html