Posted by doxogenic boy on September 3, 2009, at 16:27:16
In reply to Re: My medication history 1994 to 2009 » doxogenic boy, posted by SLS on September 2, 2009, at 16:13:25
> > > This is what I am currently taking:
> > >
> > > tranylcypromine (Parnate) 80mg
> > > nortriptyline (Pamelor) 150mg
> > > lamotrigine (Lamictal) 200mg
> > > aripiprazole (Abilify) 20mg
> > > lithium 450mg
> > >
> > >
> > > You might want to choose the SRI antidepressant that has worked best and still remains
> > tolerable - venlafaxine (Effexor) perhaps - and add a full therapeutic dose of nortriptyline. It would be interesting to add lithium to this if necessary. Once you have established this core treatment, then you can try adding other augmenters like low-dose ziprasodone (Geodon).
> > --------------------
> > Thanks for the advice, I will think about it.
> > My current combination is:
> > 1) quetiapine (Seroquel) 600 mg
> > 2) liothyronine sodium (L-isomer of triiodothyronine (T3); Cytomel, Liothyronin)
> > 20 µg (microgram)
> > 3) escitalopram (Cipralex/Lexapro) 40 mg
> > 4) tianeptine (Stablon) 150 mg
> > 5) clonazepam (Klonopin, Rivotril) 1 mg
> > 6) trimipramine (Surmontil) 100 mg
> > 7) pramipexole (Sifrol/Mirapex) 0.264 mg
> > (0.088 mg X 3)
> > I started with the pramipexole Monday. What could be the first thing to do?
> > doxogenic
> If you haven't tried adding Wellbutrin (bupropion), I would make that the first stop after your trial with pramipexole.
I have tried bupropion as monotherapy. It was activating, but after some months, it made my anxiety worse, and it lost its effect. When I used bupropion, my memory was very bad. I also have tried bupropion with bromocriptine (Parlodel), but that did not make the situation better
Bupropion may have another effect with my current combo, so I will take it into account.
> Just to let you know, I respond better to nortriptyine than I did with trimipramine.
The reason I started trimipramine, was that it probably would give more sleep and less anxiety. Isn't nortriptyline more activating and (thus?) more anxiety-provoking than trimipramine?
> How would you describe your illness?
Ambivalence, excessive worriyng, anxiety, anhedonia/lack of motivation, interest.
Small details can be insurmountable and endless problems, which make it impossible to get anything done. Lots of things I should have done, accumulates for years.
> I guess insomnia and anxiety are big issues?
Insomnia isnt any longer, because of quetiapine, clonazepam and probably also trimipramine, but anxiety is still a big issue.
> If they are, then you might want to take this into consideration if you choose to explore Wellbutrin. I would try it anyway. If your anxiety becomes significantly worse, you just stop taking it. No biggie. It is just that I have seen Wellbutrin work particularly well with escitalopram.
Interesting. I will certainly think about this.
> I am not big on tianeptine. I haven't seen it bring someone to remission yet.
My medication history the latest years, is a story about partial remission.
Big steps have been done with my current combo, but there is still a _long_ way to remission. For me, high-dose tianeptine added to high-dose escitalopram (and the other meds) made a big difference, and the strange thing is, that this improvement has been there for a long time.
The first thing that worked for more than two years in hopeless anxiety, was quetiapine; it was and is anxiolytic and good for my sleep. I can now sleep 10-12 hours, but when I was almost entirely medication-free for half a year, I slept just 5 hours.
Months with sleep restriction therapy didnt work. A polysomnographic investigation in 2005 showed that I have periodic limb movements during sleep, so maybe the pramipexole can improve my sleep quality.
> Of course, my only exposure to people who have tried tianeptine is here on Psycho-Babble.
Have anyone tried an SSRI first, then adding tianeptine up to, for instance, 150 mg?
> Is it worth taking for its neuroprotection? That's a tough decision. Although I am doing better on lithium now, I had intended to take it indefinitely, regardless of response or non-response, just for the neuroprotection and neurogenesis it might afford.
I get tianeptine nearly for free in my country, so if it has some effect and no bad interactions, it is for me no reason not to take it.
Thanks for the advice!