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Re: What combination of psychiatric drugs has worked?

Posted by Geaux Tigers! on December 9, 2012, at 18:48:32

In reply to Re: What combination of psychiatric drugs has worked?, posted by Geaux Tigers! on December 9, 2012, at 18:47:11

I've developed this chart: http://oi45.tinypic.com/14dge1u.jpg

As you can tell, I am a fan of old school TCA's. They seem to have a better response rate than SSRI/SNRI in my experience if they work well, but a lot of time the side effects are just too much.

What do you suggest I should do to improve this chart? I have a lot of ideas and want to completely re-do it.

------------------

Let me defned my use of TCA's

OK, with the Anafranil, you have a drug that is a potent enough SRI that has the same potency as the SSRIs. WHILE at the same time have strong NRI due to its desmethylclomipramine metabolite. This makes it way better than the SNRI venlafaxine which has negligible NRI effects except at ridiculously high doses. I think the NRI + SRI combination is important for depression; also, like venlafaxine and the other TCAs, it may interact with the opioid system in a beneficial way. It is a mild 5HT2A antagonist, which is good to reduce anxiety and improve mood and probably sleep too (and appetite). It does increase prolactin levels a lot so you have to watch out for that and its inhibiting effect there can interfere with the breakdown of melatonin so it might increase drowsiness but Im not sure how clinically relevant that is. Great TCA.

I recently stabilized a patient on:

#60 900mg. lithium; PO, 1 tablet QAM, 1 tablet QPM for 296.5
#90 10mg. dextroamphetamine sulfate; PO, two tablets QAM, 1 tablet QPM for 314.01
#30 125mg. imipramine PO QHS for 296.3/309.81
#60 0.5mg. clonazepam PO BID PRN for 300.02/300.23
#30 80mg. lurasidone PO QD CF for 301.83/312.30
#60 100mg. modafinil PO BID QD for 327.15/296.80
#120 150mg. pregabalin PO, two tables QAM, 1 tablet PM, 1 tablet QHS for 293.83/296.80
#30 0.5mg. alprazolam PO QD PRN for 292.84//309.81


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poster:Geaux Tigers! thread:1032714
URL: http://www.dr-bob.org/babble/20121130/msgs/1032717.html