Posted by SLS on March 18, 2018, at 11:10:40
In reply to Re:Current meds and question EDIT title » SLS, posted by Clearskies on March 17, 2018, at 23:19:43
Hi Clearskies.
> > > Both Effexor and Cymbalta pooped out on me in spectacular, gut wrenching ways. Both times I tried them. Gaaah.
> > I'm sorry to hear that. How long did your improvements last for?
> Two short weeks. I still am less profoundly depressed, but simple things like bathing and dressing are beyond me until late in the day.What was the magnitude of your response? Was it close to remission? Did your anxiety improve when you were responding? What dosages did you take? Did you combine it with Wellbutrin 300 mg/day?
I feel better in the morning. This is consistent with "atypical" depression (and often bipolar depression). Feeling worse in the morning and better at night is consistent with "endogenous" or "melancholic" depression. Do you have anxiety revolving around feelings of doom? You might want to keep that in mind when choosing medications. Tricyclics and SNRIs are thought to be better for this type of depression than are SSRIs. Perhaps you should consider adding nortriptyline. Abilify is a drug worth taking a look at, too. As an augmenter, it can enhance a partial antidepressant response. I've had luck with both Abilify and Lamictal as augmenters.
Regarding your conclusion that your mental or emotional age is 17 years, I don't think it is productive to evaluate such things until you are feeling better. Depression warps thoughts and feelings. It is a liar. Depression is an altered state of consciousness. How did you feel about these things while you were responding to Effexor and Cymbalta?
It would be helpful to know what are the dosages of the medications you take. I know you are taking Zoloft 100 mg/day. That is a moderate dosage. You can go up to 200 mg/day, as I'm sure you already know. I hope raising the dosage proves to be an answer for you. 300 mg/day is the dosage most often chosen for Wellbutrin. Why are you taking prazosin? Is it helping? What dosage? For depression, I suggest looking at 15 mg/day (5 mg t.i.d). I take 20 mg/day. 40 mg/day is the maximum.
I plan to switch from Parnate to Trintellix (vortioxetine) in a few months. It is a drug substantially different from what I have taken before. It is part SSRI and part serotonin receptor modulator. I would continue taking the other drugs in my regime. I don't think it is a good idea to take Zoloft or any other serotonin reuptake inhibitor in combination with Trintellix. There is a possibility of precipitating a state of serotonin toxicity - serotonin syndrome.
I can't predict what you will ultimately respond to, but it is reasonable to increase the dosage of Zoloft before moving on. Be sure that your dosage of Wellbutrin is high enough - usually 300 mg/day. The questions that Ed_UK asked will help you to refine your diagnosis and possibly suggest which drugs to consider. The treatments I mentioned represent alternatives. I feel that knowing that there are untried treatments can bring hope. The brain is not quite a black box anymore, but it is still difficult to know which drugs will bring the desired result for any one individual. For instance, a person can feel worse on one SSRI but feel better on another. It is interesting that you had the same response to Cymbalta and Effexor.
- Scott
Some see things as they are and ask why.
I dream of things that never were and ask why not.- George Bernard Shaw
poster:SLS
thread:1097313
URL: http://www.dr-bob.org/babble/20180212/msgs/1097437.html