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Re: Help please. I need to make some changes.

Posted by doxogenic boy on August 22, 2009, at 17:59:29

In reply to Re: Help please. I need to make some changes., posted by zana on August 22, 2009, at 14:09:44

> Seroquel had a very modest AD effect at 300mgs.

Maybe it can work at higher doses?

My experience with Seroquel (quetiapine) is good. Of course, nothing is good for everyone, but sometimes we haven't had the persistence to try for instance high-dose therapy. Endurance is needed to wait for side effects go down, and then, if there was no effect, try a higher dose etc.

But it is difficult to say when it is enough, especially if the pasient is thinking of suicide.

In a hopeless chronic depression where I thought I had tried everything and I thought there was _nothing_ left to try, December 2006 Seroquel was added to the combination of escitalopram (Lexapro/Cipralex), Lyrica (pregabalin) and trimipramin, gradually up to Seroquel 600 mg, the latter I still use in the same dose.

Seroquel took up to months before the side effects faded out, but I am glad that I had patience to maintain it. It didn't lead to remission, but it had a good effect for sleep, against anxiety and it was mood-elevating.
The antidepressant effect of Seroquel took at least a month to show.

"Efficacy, safety and tolerability of quetiapine augmentation in treatment resistant depression: an open-label, pilot study."

"[...] In the Montgomery-Asberg Depression Rating Scale (MADRS) analysis, the difference between the quetiapine and lithium group was significant from day 28 onwards (p < 0.05), with subjects improving more in the quetiapine group than the lithium group[...]."

My recommendation:

100 mg Pristiq
700 mg Seroquel - slowly increase, during months
300 mg Wellbutrin
600 mg Lyrica (300 mg twice a day)
and the others...

45 mg Remeron
1 mg Risperdal
3 mg Klonopin
600 mg Gabapentin
200 mg Provigil: slow as possible, taper down and quit.





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