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Re: Gillmore (again) SLS » jono_in_adelaide

Posted by SLS on January 17, 2013, at 22:55:11

In reply to Re: Gillmore (again) SLS, posted by jono_in_adelaide on January 17, 2013, at 17:10:07

> Scott,have you got any clinical pearls you can suggest to gillmore beyond my suggestion of zoloft plus an NARI based on his prior experiences detailed on the thread above, before he goes down the path of ECT?


I will need to review the thread. Unfortunately, it is getting late.

It is true that many people find Wellbutrin to be too activating and anxiogenic. However, there are some for whom it is exactly the right drug to regain energy and vigilance, but not always drive and motivation. Adding a serotonergic drug can act as an adjunct to Wellbutrin and help to brighten mood and recover interest and desire to initiate activities. Unfortunately some people will find one SSRI or another to produce apathy and amotivation as unwanted effects. I know of no way to predict which of these drugs will produce these effects for any one person. I think Zoloft has the reputation for having milder side effects. The combination of Wellbutrin and Zoloft is sometimes referred to as "Welloft". Effexor or Pristiq can be great adjuncts to use with Wellbutrin. A friend of mine felt moderately better using a combination of Wellbutrin and Lexapro. It wasn't until she switched from Lexapro to Pristiq that she finally attained remission.

I guess every doctor will have his favorite psychotropic drug treatments. Every patient will have his favorites, too. Psychiatry is an art trying very hard to be a science. It is not quite there yet. I haven't been following Gilmourr's story, so I really can't comment on his approach towards recovering mental wellness at this point. However, as Jono has suggested, I think it generally makes sense to try several polypharmacy drug combinations before undergoing ECT. A severe, suicidal, melancholic depression might qualify for the immediate application of ECT. Even here, there is not always agreement between doctors as to the protocol suggesting where to place the electrodes, the frequency and power of the current used, time of seizure, percentage of motor threshold, etc.

Since it is on my mind, I would offer that Paxil is a powerful SSRI that some people require to achieve a robust therapeutic response. It works. Unfortunately, it is prohibited from being used by women during pregnancy. It is teratogenic and can lead to fetal heart valve defects. Weight gain is often a problem, and if the drug must be discontinued, withdrawal effects can be difficult to manage.


- 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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