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Re: Best AD for Melancholia » SLS

Posted by brynb on July 11, 2016, at 17:23:25

In reply to Re: Best AD for Melancholia » brynb, posted by SLS on July 11, 2016, at 16:16:30

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

I can't say how much Lexapro is helping anymore. I've been on and off it for many years (trying other things for short periods in between) but eventually go back on it as I seemingly have few, if any, side effects from it. It's probably helping my anxiety a bit but i don't think it's working on my depression at all. When I was prescribed Tramadol, there was a big contraindication in taking it w/a SRI or NRI but I didn't have any issues with serotonin syndrome. I will ask my pdoc tomorrow about starting at the lowest dose of Anafranil and possibly lowering my Lexapro from the current dose of 20mg.
>
> > 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.

That's very promising!

> 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.

I've tried nortriptyline in the past with lexapro and didn't like it, though I can't remember why.
>
> You might think to add memantine for OCD if you get stuck.

This was recommended to me earlier in the thread. That's off-label, correct? Anything else about memantine that could be helpful?

> 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.

I'll ask my doc about his thoughts on my Dx. I try not to get too caught up with it. I never thought I had clinical OCD but many of its symptoms resonate with me. I'm on disability for MDD and GAD but I also display Bipolar 2 symptoms. Sadness and intrusive thoughts/rumination have always been pronounced features of my depression. Regardless, I'm least concerned with a proper DX (though it could be helpful) and more interested in taking medication that addresses everything.

I obviously have a lot to think about and present to my doc. We just began working together, but I really like that he is an addiction specialist and very seasoned in psychiatry in general. He's been on the best pdoc list in Castle Connelly for years.

Thanks again!
>
>
> - Scott


Live in the sunshine, swim the sea, drink the wild air. - Ralph Waldo Emerson


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poster:brynb thread:1090338
URL: http://www.dr-bob.org/babble/20160609/msgs/1090403.html