Posted by bleauberry on January 26, 2010, at 17:25:46
In reply to consult results, posted by floatingbridge on January 26, 2010, at 0:43:15
Dopamine responder? Well, that makes sense, based on a verbal inventory of history and symptoms which he did. Not to rain on the party, but in the real world, the only way to know if someone is a dopamine responder or not is to try that route and see what happens.
The quickest method I know of is called the Methyphenidate challenge. Ritalin is a quick way to see if the DA/NE route is on the right track or not.
I'm puzzled by the Remeron. It does have some indirect effect of boosting the firing of NE, indirectly stimulates dopamine a little bit, but does nothing to increase levels of either. Based on scientific studies, it does not actually increase levels of any neurotransmitters. First and foremost, it is one of the planet's most potent antihistamines.
In combo with Pristiq it would be an updated California Rocketfuel, claimed to be a potent antidepressant cocktail. It has been with a few people here. In the STAR*D study, it wasn't very impressive. But then, at that stage of the game, it was a very difficult sample population of multidrug failure patients.
Lithium low dose makes sense no matter what the AD is. No guarantees, but it makes sense. I like that it is a natural substance. Doses as low as 100mg to 300mg can be felt. I swear, when I tried 100mg a few years ago, it felt like amphetamines. Higher doses felt like benzos. But that's just me. Everyone is different. Few treatments have as much history and track record as lithium.
A low dose ssri (preferably Prozac) with brand name extended release Ritalin makes sense to me. And if the diagnosis is double depression with a suspicion of dopamine responder, the one and only monotherapy I know of that fits that bill perfectly is Savella.
Common doses of Remeron include 15mg and 30mg. Some go up to 45mg. I've heard of doses as high as 90mg. I found 3mg to 7.5mg to be profoundly more sedating than higher doses. It felt like the NE stimulation was beginning in the 7.5mg range, but absent below that. Just how it felt. I can tell from what my tinnitus tells me. Expect some sedated drugged days in the beginning. It will mostly pass as the body adjusts to the antihistamine effect.
I'm very happy you had an encouraging meeting. I think something good will come from it.
poster:bleauberry
thread:935008
URL: http://www.dr-bob.org/babble/20100122/msgs/935065.html