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Re: ketoconazole, ECT and I just need a support Slabicki

Posted by SLS on August 10, 2012, at 8:03:32

In reply to Re: ketoconazole, ECT and I just need a support SLS, posted by Slabicki on August 9, 2012, at 22:49:36

Hi Slabicki.

I'm a little surprised that you didn't respond at all to Lamictal, even transiently. My initial thoughts were that dopaminergic (DA) drugs might help you. I see that some of your responses to various drugs are consistent with this idea. That doesn't guarantee that you will ultimately respond to a dopaminergic drug, but it is interesting.

Some people continue taking, or begin taking, medication after successful ECT. They believe that it has prevented relapse. A drug doesn't have to act directly on dopamine neurons to produce an increase in dopaminergic activity. Prozac is an example of a drug that can increase DA in important areas of the brain (prefrontal cortex) by modulating serotonin activity somewhere else upstream.

You might consider combining drugs. Wellbutrin + Effexor might be worth considering along with adding low-dosage lithium. It is too bad that you had a difficult time with Parnate. Perhaps Nardil would be easier for you to tolerate. It is less amphetamine-like than Parnate. It can be combined with Wellbutrin. I would also consider trying, Wellbutrin + Lamictal + Abilify if DA is to be a target.

My guess is that there are quite a few drug combinations treatments yet for you to try. I hope it doesn't take that long to find one that works.

> Thank you Scott for your post. I hope you feel

I am doing better than I was 10 years ago. I recently added a drug that modulates norepinephrine (NE) activity - prazosin. Prazosin is now being used to treat PTSD, but it might have other applications in psychiatry. I am still not ready to go back to work, though. I may have no choice but to remain patient and allow the antidepressant response to grow over time. However, I am looking at the glutamate system as another angle of attack to accelerate my recovery. Lamictal reduces glutamate activity. I am hoping to potentiate its anti-glutamatergic activity with drugs like memantine, ketamine - or even N-acetylcysteine (NAC). I will note here that a single molecule will often have multiple diverse properties that can be useful to treat unrelated illnesses. Amantadine is an example of this. It exerts both antiviral and and anti-parkinsons effects. Amantadine has even been used as and antidepressant. Some synthetic tetracycline antibiotics are capable of reducing inflammation in the brain through mechanism unrelated to its antimicrobial effects. Brain inflammation is associated with mood illness, although it might not be the direct cause of it.

Here is my current treatment regime:

Parnate 80 mg
nortriptyline 150 mg
Lamictal 200 mg
Abilify 10 mg
lithium 300 mg
prazosin 12 mg

This looks like a lot of drugs. I have tried to remove each one of them with the exception of lithium. I always relapse. If there were a single molecule that contained all of the drug mechanisms to be found in this combination, that would be fine. Personally, I don't care very much what my treatment looks like to other people or how the job gets done. I consider this to be rational polypharmacy.

- Scott

Some see things as they are and ask why.
I dream of things that never were and ask why not.

- George Bernard Shaw




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