Posted by SLS on July 19, 2012, at 6:25:15
In reply to Re: Melancholic Depression, posted by bleauberry on July 19, 2012, at 5:31:08
Hi BB.
> While scientific studies do not completely back up my opinion here, I am convinced melancholic depression resides mostly somewhere within the norepinephrine/dopamine circuits. Some of the meds you took were sort of partially working in that area but not really much.
>
> Ideas to consider:
> Do not count on any single med to do the job.
> Think in terms of SSRI + TCA, to get a balanced approach to both serotonin and norepinephrine. Such as zoloft+nortriptyline, prozac+nortriptyline, and similar variations.
> My personal opinion is that if an ssri is to be considered in the mix, prozac is the best of the bunch.
> See if you can get just a few samples doses of Ritalin and Adderall. These work instantly, so they are a good probing test. Your response to them, either good or neutral or bad, will tell you a lot that will help guide future medication decisions.
> No matter what meds you take, try including the herb Rhodiola Rosea with them.
> The MAOIs should be considered if the above ideas don't work out well.
> I am very familiar with other types of medical problems, mostly in the infectious disease areas and toxicity areas. Specific kinds of depression are almost hallmark clues with most of them. So regardless of what you do in terms of meds, I think it is wise to do what you can to "probe" for possible hidden causes, which is fairly easy to do with a handful of certain herbs. If your depression came out of nowhere for no apparent reason and it happened in a relatively quick timeframe, that would tend to point me in the direction of an "event" as the cause, such as a tick bite, exposure to something, hard to know for sure but something happened.
BB - I think you are pretty much on target here, although I am not so sure about the Zoloft. I would be more inclined to choose Effexor as an adjunct. You could be right, though. Sheldon Preskorn would probably agree with you. Remeron might be an interesting choice for monotherapy. Regarding MAOIs and TCAs: According to more recent research, TCAs don't work as well for atypical unipolar depression as MAOIs, but MAOIs seem to work about as well as TCA for melancholic depression. I don't think there is any literature dealing with this, but think I would choose amphetamine over methylphenidate as a biological probe, especially if psychomotor agitation is present. Amphetamine might help for a few hours to a few days, but that might be enough reason to pursue TCA or MAOI.I wish I knew these things for sure. I don't. Of course, if I did, I would probably be writing papers. It is difficult to navigate the sea of conflicting literature.
- Scott
Some 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:1021725
URL: http://www.dr-bob.org/babble/20120718/msgs/1021750.html