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Re: Desperation!! And now Luvox? » papillon2

Posted by SLS on August 28, 2012, at 6:48:04

In reply to Re: Desperation!! And now Luvox?, posted by papillon2 on August 28, 2012, at 2:35:41

> I have melancholic depression which involves pronounced psycho-motor retardation, so I need something activating.

> I was on Luvox for one or two weeks. Probably one actually. It completely flattened me; I could barely walk or talk.

I would keep exploring tricyclics and MAOIs and look to add things like lithium and T3. This is "old school", but there was quite a bit of evidence that this strategy worked for endogenous (melanchoic) depression. It is not true that MAOIs are inferior for endogenous depression. It is true that tricyclics are inferior for atypical depression. You might consider combining Parnate with desipramine if you want to stress NE activation. This is the only treatment that brought me to full remission. I would probably still be well on it were my doctor at the time had not had me discontinue it in favor of playing with Prozac and other drugs. Psychomotor retardation is a prominent symptom of my illness.

Imipramine is the drug of choice for your kind of illness. Clomipramine might be too serotonergic for you.

Viibryd is an interesting serotonergic drug. Phiddipus has been responding to it for quite awhile now. I did not experience apathy or flat affect with it. Nor did I experience sexual side effects. Fluvoxamine is generally considered to be the least activating SSRI. It is probably better for OCD than it is for depression.

I am not a big fan of Savella, but you might want to take a look at it. Even at low dosages, it provides a balanced NE/5-HT ratio for reuptake inhibition. Otherwise, using Effexor at dosages of 300 mg/day and higher might help, particularly when combined with nortriptyline. I maintained a partial response to this combination whereas monotherapy with each drug was without therapeutic effect.

As adjunctive treatment, two antipsychotics that come to mind are Abilify and Seroquel. Geodon might be helpful, but the drug is a bit unpredictable. Some people are reporting success being treated with tramadol. Like imipramine, Geodon and tramadol both inhibit the reuptake NE and 5-HT. Of course, tramadol also modulates the opioid system (mu agonism with very little kappa and delta agonism). One needs to be wary of combining tramadol with a SRI as it can produce serotonin toxicity. Perhaps combining tramadol with a tricyclic would help. Do NOT combine tramadol with a MAOI. Serotonin syndrome has been reported with this combination.

http://www.ncbi.nlm.nih.gov/pubmed/16051647

Have you tried high-dose Remeron (45 - 90 mg/day)? It would be interesting to combine it with desipramine.


- 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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