Posted by papillon2 on March 19, 2012, at 21:50:26
In reply to Re: What do you think of abilify at a low dose for Uni » papillon2, posted by SLS on March 16, 2012, at 5:51:07
> What does your diurnal pattern look like? Do you feel worse in the mornings? If so, then you might have a classic endogenous melancholic depression. This would indicate that you are probably be more apt to respond to tricyclics.
Yes, as you guessed further down I have melancholic depression. I am worse in the mornings. I am responding to Nortriptyline.
> > - still some psychomotor retardation / leaden paralysis but no where near the same extent (was in a freaking wheelchair and unable to talk)
>
> OMG. I am SO sorry. You were very sick. It angers me to hear this.
>
> Psychomotor retardation would be sufficient to explain this, though. Classic leaden paralysis might not apply to you. If it does, then I would entertain the idea that there might be some bipolarity going on.Basically, when I am at my sickest I am unable to move as I have no energy and my limbs feel very heavy. It is more than just not having the motivation to move. I was told this was leaden paralysis.
I was screened more than once for bipolar, but I don't experience mania or hypomania.
> > Currently:
> > Nortriptyline 100mg (blood level 0.5, I suspect any higher would just make me miserable from side effects).> Give it a try anyway. You might be VERY surprised. I suspect that you are an extensive metabolizer and that you will need 150 mg/day to reach full remission. Get closer to 150 ng/ml than to 50 ng/ml. For me, side effects are no greater at 150 mg/day than at 75 mg/day. Side effects might get worse immediately upon a dosage increase, but they should decrease over time. After being on nortriptyline for an extended period of time (months), you might not even know that you are taking it. I hope this is the case for you. Even if side effects linger, they should be reduced. I am SURE you will find it to be a worthwhile trade-off if increasing the dosage works.
I might give it a try if other options seem worse. I have two concerns:
(1) I believe the palpitations and chest pain would resolve in about a month as they have on previous dose increases. However I think my resting heart rate would increase further (currently 25bpm above my usual rate due to Nortriptyline) and I think it contributes to my anxiety. It is not that I am anxious ABOUT it, it's just that it is a very much like anxiety. Not surprising given a racing heart rate is a symptom of anxiety. It is like having high adrenaline coursing constantly through me.
(2) My eyes which are dry from Nortriptyline are especially bad in the mornings and I think it contributes to my feeling bad in the morning and wanting, and going, back to bed. I know however that I need to be more diligent with using eyedrops for this purpose but motivation is an issue. Surprise!> > Lamictal 200mg
> > Lithium 125mg (blood level 0.2, can't go higher as super sensitive)
> > And melatonin 3mg
>
> That is a sufficient blood level of lithium for it to exert an antidepressant effect when used as an adjunct to antidepressants. It is far too low to address bipolar mania. For me, lithium at 300 mg/day results in the same blood level as yours. Going higher in dosage does not produce an increased therapeutic effect. It just brings on apathy and amotivation.This is really good to know. I don't have mania so controlling mania is not an issue. I think doctors assume my Lithium is too low to be helping but I think it does and I like it's beneficial effect on the brain.
> > My psychiatrist suggested Epilim (a valproate) but has forgotten that she took me off it as I was shaking all the time.
>
> Combining lithium and valproate acts synergistically to produce shaking. Valproate by itself might not be so bad.
>
> > Her colleague, who specializes in melancholic depression, has suggested Doxepin and/or a course of ultra brief right unilateral ECT. I have refused the latter at present.
>
> Ah, so you are melancholic after all? That was an easy guess to make.Yup.
> You might profit from adding a MAOI to bring you to full remission if your depression is a hybrid between melancholic and atypical. Actually, this is what bipolar depression looks like; with symptomology looking more atypical. How is you appetite / body weight? What time of day do you feel worst? Is it a regular cycle? My mood was actually worst at 2:00 PM. This is not terribly common.
My mood and energy are worse in the morning; this is a very regular cycle. My appetite and weight decrease with depression. I have to closely monitor both as I used to have anorexia nervosa and losing too much weight can trigger it.
I am told that for melancholic depression ECT > MAOI > TCA > TeCA > SNRI > SSRI, so I may have to try a MAOI eventually.
Ring the bells that still can ring
forget your perfect offering
there is a crack in everything
that's how the light gets in
~ Leonard Cohen
poster:papillon2
thread:1012966
URL: http://www.dr-bob.org/babble/20120316/msgs/1013476.html