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Re: Long-Term Users of SSRI's--Need Your Help

Posted by crittercuddler on December 16, 2008, at 3:12:52

In reply to Long-Term Users of SSRI's--Need Your Help, posted by NewQuestions on October 15, 2008, at 14:26:24

Stephen Stahl recommends adding or switching to agents that act to increase NE or DA in order to combat the apathy syndrome or "apathetic recovery". I see that you said that your depression did indeed lift when you took Cymbalta, Effexor, Remeron, and Wellbutrin, which all work on NE, DA, or both... so that supports that theory. I am making that statement based on what I have read (and can see) from the book Essential Psychopharmacology by Stephen Stahl. (which is partly viewable online). You are having a problem with anxiety, insomnia, and jitteriness... Knowing that I would recommend you try augmenting an SSRI or an SNRI or Remeron as follows below....

SARIs play an important role as well. What is an SARI? This could be nefazodone or trazodone. This class of drugs is a potent antagonist of 5HT2A receptors. (The stimulation of these receptors is linked with the insomnia, anxiety, agitation, and akthasia (restlessness) that SSRIs can cause. So, by antagonizing these receptors SARIs can help with sleep and anxiety. Antagonism is also linked to helping depression. At the same time SARIs less potently inhibit serotonin and NE reuptake and thus work as an anti-depressant that way as well. And by inhibiting NE reuptake they can increase dopamine. Atypical antipsychotics and the TCA nortriptyline have 5HT2-A antagonism as well.

With that being said I am going to try and suggest some combinations....

a. SSRI at regular dose plus a SARI at a low to moderate dose (like trazadone)

b. SSRI at regular dose plus the TCA nortriptyline at a lower dose

c. SSRI at regular dose plus buspirone at regular dose (Buspirone is postulated to help reverse anti-depressant poop out)

d. Remeron plus Modafinil- (Remeron has 5HT2A antagonism) and you could take the Modafinil for the sleepiness

e. Effexor plus an atypical anti-psychotic that is a 5HT2A antagonist (like Risperdal, Seroquel, or Zyprexa)

f.Effexor with an SARI

g.Effexor with Nortriptyline

h.Buproprion and an SSRI?

This stuff is so hard for me to wrap my brain around tonight.

PLEASE by all means take these as suggestions to investigate further and ask your doctor about. From what I have read today I believe the combinations I suggested make sense... but I would clarify on your own and with your doctor and others on this forum to be doubly sure.


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poster:crittercuddler thread:857586
URL: http://www.dr-bob.org/babble/20081214/msgs/869050.html