Posted by SLS on May 12, 2012, at 9:19:12
In reply to Suggestions for meds augmentation? (BP2, GAD, MDD), posted by LouisianaSportsman on May 11, 2012, at 23:03:16
Hi.
I'm pretty sure that people are having a difficult time suggesting things for you. You have quite a few things going on, and you have been on some sophisticated treatment regimes. I don't think I can offer any new ideas for you.
My first question is to know whether or not you have had any psychotherapy. My second question is what is your family history with regard to mental illness.
Have you tried Trileptal (oxcarbazepine or Tegretol carbamazepine)? These two drugs are cousins and are reported to reduce impulsive behaviors and anger, and are often chosen in combination with an antipyshotic to treat BPD. I have seen Zyprexa work well in this role.
Believe it or not, Topamax 100 mg can work well when bipolar mixed-states are present. If one begins at 25 mg and increases the dosage by 25 mg per week, much of the cognitive side effects can be avoided.
Nortriptyline is a good TCA that goes well with SRI drugs like Zoloft and Effexor.
Abilify makes a good augmenting agent when combined with Lamictal.
Anafranil (clomipramine) is probably the most effective tricyclic available. It acts as a SNRI and has anticholinergic (muscarinic) properties. There are some who believe that anticholinergic agents can act as antidepressants. There is some work currently in progress investigating intravenous scopolamine.
Which MAOIs have you tried?
You might have a bipolar spectrum disorder with comorbid ADHD. Low-dosage lithium (300-600 mg/day) could be helpful along with the Lamictal and Klonopin to help contain the mania, stabilize mood oscillations, and prevent rapid cycling.
Adding the Seroquel is justified according to the clinical studies that have been performed on it. You won't know how the drug effects you until you reach dosages of 200 mg and higher. Weight-gain? I don't know if this applies globally. Try it and see what happens. The metabolite of Seroquel is a norepinephrine reuptake inhibitor.
From your own reporting, it seems that retaining the Klonopin is a good idea, regardless of in what direction you choose to go.
Personally, I like Abilify, Lamictal, Effexor, and nortriptyline. Some people have been voicing a preference for Zoloft to combine with nortriptyline.
Geodon and Latuda are two antipsychotics with antidepressant properties that are usually are devoid of weight gain. Saphris, another antipsychotic, is being investigated for treating bipolar mixed-states and bipolar depression.
Namenda (memantine) might be helpful as an adjunct to the stimulant for treating ADHD. It does not seem to work for bipolar depression, but it seemed to help me a bit when I combined it with Parnate.
Do any of these ideas appeal to you?
For Bipolar IV (depression with mania generated by medication only), I take:
Parnate 80 mg
nortriptyline 150 mg
Lamictal 200 mg
Abilify 10 mg
lithium 300 mg
prazosin 8 mgGood luck.
- ScottSome see things as they are and ask why.
I dream of things that never were and ask why not.- George Bernard Shaw
poster:SLS
thread:1017746
URL: http://www.dr-bob.org/babble/20120508/msgs/1017758.html