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Re: Best AD for Melancholia » brynb

Posted by SLS on July 11, 2016, at 16:16:30

In reply to Re: Best AD for Melancholia » SLS, posted by brynb on July 11, 2016, at 15:29:42

> > Ruminations and intrusive thoughts are known to be symptoms of melancholic depression. If true OCD is comorbid with melancholic depression, clomipramine (Anafranil) is a drug to explore.
>
> Can Anafranil be added to my current 20mg of Lexarpro?

Theoretically, serotonin syndrome can be a complication of this combination. How much is the Lexapro helping?

> And theoretically this would potentially address OCD & melancholic depression?

I am thinking that clomipramine would address both. Clomipramine is a TCA with added SSRI-type actions. It is so good at doing the job, that doctors were writing prescriptions for it and having their patients fill them from Canadian pharmacies because it had not been approved in the USA yet.

> > I've had partial success with adding nortriptyline to a SNRI.

> For melancholic depression, OCD or both?

I have bipolar depression without OCD.

Because clomipramine has anticholinergic side effects (dry mouth, blurred vision, constipation, difficulty urinating, etc.), you might want to first try adding nortriptyline or desipramine to Lexapro or Luvox.

You might think to add memantine for OCD if you get stuck.

From your description, I think I would act under the premise that you have melancholic depression without OCD. Work with your doctor to get a comprehensive screening for OCD if you are in doubt.


- 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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