Posted by nelag on April 24, 2012, at 22:53:07
Hi All,
I am not completely new to psychobabble but have not posted in more than ten years. I could use advice from anybody who can give it.
Here is my situation. I have had episodes MDD since I was 27; I am now nearly 60. When the MDD was finally diagnosed after a brutal 2 years I was put on four medications for sufficient time at a sufficient dose. None worked. I don't remember the names of the meds but two were tricyclics and two SSRIs. After these four failed my pdoc put me on Parnate. It was slow to take hold but after it did it worked fine for a number of years and gave me few problems with side effects.
Not long after Effexor came out I switched to it for the convenience of a restriction free diet. Effexor has also also worked well for me, at first at a dose of 225mg. After a couple of years I crashed and was titrated up to 450 Effexor. During this rapid titration I began Welbutrin at 300mg as augmentation. This combo held me for a couple of years and then I crashed again. I titrated to 600mg Effexor, keeping the Welbutrin in place. My doctor was one of the few who seemed to have acurately read the PDR to say that 350 was highest dose found effective during a brief clinical trial. Quite different than saying that higher doses taken over a longer stretch of time could never be effective or that doses over 350 were dangerous. Over a period of several more years I titrated incrementally until stopping at 1,200. At one time I thought this might constitute a world record but I was disabused of this bragging right by a gentleman on another site who said he was currently at 1,500. In any case, this dose was effective until about six years ago when I began having breakthroughs of depression lasting from several days to several weeks. Since then these breakthroughs have become steadly more frequent to the point that I sense the Effexor losing its puncb altogether. So I will probably make a change soon.
Here is my question (finally!). Should I take option number one and return to Parnate or option two, which would be to add a second augmenting drug to the Effexor? The chief downside of the first option is having to take two or three weeks to get off Effexor, (I have always been able to get off and on meds quickly.)followed by two weeks of washout until beginning Parnate and waiting another month for it to, I hope, kick in. When I switched in the other direction many years back I spent I spent a number of weeks in bed unable to get up for any activity aside from showering.
The possible downside of option two is that I don't know if a second titrating med is likely to potentiate the Effexor. And if so, which drug or drugs would be most likely to do this. MDD is my only diagnosis--no bipolar,ADHD or any other malady on board.
If anybody can share their experience, perspective,knowledge or advice on the augmenting issues, especially what medication to use, it would help me a lot. My original pdoc moved out-of-state and the two I have seen since then have sometimes known less than I do, an alarming fact since I don't know much. This point is driven home everytime I read one of SLS's excellent posts.
Thanks,
nelag
poster:nelag
thread:1016352
URL: http://www.dr-bob.org/babble/20120411/msgs/1016352.html