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Re: New Regimin - still have some depression

Posted by LouisianaSportsman on May 11, 2014, at 21:23:36

In reply to Re: New Regimin - still have some depression » phidippus, posted by klein on May 8, 2014, at 6:54:47

> > Diagnosis: Bipolar/ADHD/OCD
> >
> > Rx:
> >
> > Lithium 1200 mg (mood stabilizer)
> > Brintellix 10 mg (to treat OCD)
> > Geodon 160 mg (to treat bipolar and OCD)
> > Vyvanse 70 mg (treats ADHD and OCD)
> > Keppra 3000 mg (mood stabilization)
> >
> > All I have is some minor depression. If anyone has any ideas for treating it I'm all ears.
> >
> > Eric
>
> Hi Eric,
>
> How about lowering your Geodon dose? According to Stahl high doses such as 160mg can be effective for very rapid cycling, but to get antidepressant effect a lower dose is recommended (20mg-40mg BID). The NE reuptake inhibition takes a while to kick though.
>
> Small dose of Wellbutrin SR?
>
> How is the Keppra working for you? Maybe you could augment it with stabilizers with a higher AD profile such as gabapentin or Lamictal or even LYrica.
>
> How about increasing the dose of Brintellix?
>
> Tricky diagnosis..

Hey, look, some of my forum favorites in two quotes!

Yeah, klein, I think I brought up switching Latuda to Geodon in the past over to what Stahl considers to be a subtherapeutic, primarily 5-HT2C active, NE inhibiting lower dosage ziprasidone. It's on my list of ideas along with Eric's Keppra (gabapentin and bupropion were my last two medications I have went *off* of, actually)

Eric, I'll save you my best best advice for last.

I see your five meds and will raise you six (went off Lamictal XR recently in favor of seizure target dosage (where you actually lose the weight I've now learned too) Topamax XR.

I was just on Lamictal for so long prescribed by my older PDOC, and I just stayed on it because I wasn't any other mood stabilizing drugs. I never saw what it did for me, and now I am on other mood stabilizing drugs, I have decided to cease it. I don't notice anything negative about discontinuation. Have since brought back Nuvigil.

I would be on a lot more medicine, but I just don't want to be on so many now. I was once on a max of eight! I also don't want anything addictive (says the guy with a new meth prescription) I ran out very slightly, yet still early on Xanax XR so I switched to Klonopin 0.5mg. BID which I feel would be the minimal effective benzodiazepine and dosage for me that I can stick with. I feel comfortable with these six and hopefully sticking with this:

Brintellix 20mg. (treats depression)
Desoxyn 30mg. (treats ADHD)
Klonopin 1mg. (treats anxiety)
Latuda 80mg. (treats bipolar)
Nuvigil 250mg. (treats ADHD)
Topamax XR 400mg. (treats bipolar)

There is still bipolar depression and anxiety manifesting itself covered with sluggish ADHD symptoms, however, even with the classic effective dosage mood stabilizer on top of an approved bipolar depression medication on top of antidepressant for BP and associated depression, top-notch stimulants for ADHD and a benzodiazepine. Ugh! I need ideas too, Eric. I'm more than happy to steal the good ones.

Lower doses of buspirone may be anxiolytic and tolerable? It can also generate more dopamine in lower dosages which might be relevant if you tried it unsuccessfully in the past and perhaps tried to dose too high while higher doses tend to negate it or antagonize them (notably D3 receptors, I believe). I've been wanting to know what a dopamine boosting maximum dosage would be? Going off this paragraph from this study:

" Buspirone at 1.25, 2.5, 5 mg/kg, ip neither induced catalepsy nor antagonised apomorphine stereotypy but did potentiate dexamphetamine stereotypy and antagonised cataleptic effect of haloperidol and small doses of apomorphine. Buspirone at 10, 20, 40 mg/kg, ip induced catalepsy and antagonised apomorphine and dexamphetamine stereotypies. Our results indicate that buspirone at 1.25, 2.5, 5 mg/kg blocks only presynaptic nigrostriatal D2 DA autoreceptors while at 10, 20, 40 mg/kg, it blocks postsynaptic striatal D2 and D1 DA receptors. Furthermore, buspirone at 1.25, 2.5, 5 mg/kg by selectively blocking presynaptic nigrostriatal D2 DA autoreceptors, increases synthesis of DA and makes more DA available for release by dexamphetamine and during haloperidol-induced compensatory 'feedback' increase of nigrostriatal DAergic neuronal activity and thus potentiates dexamphetamine stereotypy and antagonizes haloperidol catalepsy."

Indian J Physiol Pharmacol. 2007 Oct-Dec;51(4):375-86.
Effects of buspirone on dopamine dependent behaviours in rats

I believe the authors were seeing if they could use Buspar to treat catalepsy based on the results with DA in rats.

Also, I've seen that you've been on 70mg. of Vyvanse for a long time and maybe more dexamphetamine could help? I find methamphetamine to more of an antidepressant and a methamphetamine booster is something you and your doctor should discuss. Maybe halving your Geodon dosage (you have the lithium on board for the mood stabilization quality of the 160mg. effective dosage with the lithium) to 80mg. along with two 5 (7.5)mg.'s Desoxyns (Dexedrine) [remember 70mg. Vyvanse is made by Shire to be analogous to dexamphetamine which by strength = to 30mg. Adderall XR] later on in the day could make a tremendous impact with some low dose (15mg. PM, 7.5mg. AM? would be would I'd try) Buspar for a anxiolytic DA whirlwind? Always see if you can tolerate Brintellix 20mg.

Sum-Up of Various Ideas:

> > Lithium 1200 mg (mood stabilizer)
> > Brintellix *20 mg (to treat OCD)
> > Geodon *80 mg (to treat bipolar and OCD)
> > Vyvanse 70 mg (treats ADHD and OCD)
> > Keppra 3000 mg (mood stabilization)
> > *Buspar 22.5 mg
> > *Dexedrine 15 mg
> > *Nuvigil 150 mg.

Just wanted to offer something. You could just switch to the Dexedrine Spansules if you're trying to be on a higher dosage/efficient. Also, have you tried Focalin? Many times depression can manifest itself because the ADHD isn't being effectively treated.

Therefore, my top-notch advice would be armodafinil for off-label depression and perhaps to help with any ADHD symptoms you might still have?



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poster:LouisianaSportsman thread:1065359
URL: http://www.dr-bob.org/babble/20140419/msgs/1065505.html