Posted by metric on March 16, 2009, at 17:29:27
In reply to What medication should I try after all has failed?, posted by Girlnterrupted78 on March 11, 2009, at 21:46:13
> The single ONLY one that worked WONDERS was Celexa (and to some extent Adderall--but only for like a month.)
>
> Celexa changed my life for a whole year. I was smiling literally every second, talking to everyone all the time, dating, meeting new people, etc. I was super creative and funny very naturally and spontaneously. I feel that was probably the "real" me, (when my personality was not clouded and flooded with depression and anxiety.) But Celexa pooped out after 1 year. Nothing has worked ever since.
>
> Now my doctor doesn't know what to try next. I don't know either. Based on my chemistry, it seems like my problem is dopamine. But I tried Nardil precisely for that, and it didn't work. Yet adderall (a dopaminergic agent, I think) was great.
>Hi Girlnterrupted,
IMO, all of the "antidepressants" suck and require some form of augmentation -- if they are to be used at all. Your lackluster response to traditional antidepressants is not surprising; whether they are more effective than placebo has been a matter of considerable debate in the medical scientific community.
You mentioned Adderall worked great for a while. Were you taking anything else with it? How much Adderall were you taking when it stopped working?
As I commented to someone else in another thread, I think dextroamphetamine (Dexedrine, DextroStat) is a better choice of stimulant than Adderall. Adderall is composed of a mixture of both dextro and racemic amphetamine salts. Since levo-amphetamine has more pressor and less central activity than its dextro counterpart, d-amphetamine has a more favorable ratio of CNS/ANS stimulation (i.e., pure d-amphetamine should cause less jitteriness per unit of mental stimulation than Adderall, and be less cardiotoxic). Doctors seem to prefer Adderall more for political reasons, but there is no rational basis for him/her to keep you from switching to d-amphetamine if so desire. DextroStat sounds less sinister than Dexedrine, so it might be expedient to mention the former if brand names are mentioned.
Some people find that low-dose selegiline can restore/maintain the effectiveness of CNS stimulants such as d-amphetamine or methylphenidate, but the combination should be approached very carefully (selegiline inhibits the metabolism of catecholamines). A low dose of mirtazapine (Remeron) at night can help with sleep and counter excessive stimulation. If this is attempted, I'd only add selegiline when/if the stimulant loses effectiveness.
You've tried Nardil. What about tranylcypromine (Parnate)? Have you tried them with stimulant augmentation?
Have you tried Modafinil?
Benzodiazepines: have you tried alprazolam (Xanax) and/or clonazepam (Klonopin). They sometimes work for depression as well as anxiety, but this seems to require considerably higher doses than most shrinks typically prescribe. There's some evidence that tolerance to the sedative effect of benzodiazepines develops to a disproportionately greater degree and/or rate than tolerance to the anxiolytic effect, which of course is a desirable scenario. Unfortunately, I can't comment on the strength of that evidence.
Are you taking an AD currently? SSRIs often cause terrible fatigue and emotional numbness (this usually develops over time and sometimes insidiously).
poster:metric
thread:884934
URL: http://www.dr-bob.org/babble/20090313/msgs/885651.html