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Re: Any experience with Trintellix?

Posted by linkadge on April 27, 2018, at 13:52:18

In reply to Re: Any experience with Trintellix? linkadge, posted by SLS on April 27, 2018, at 11:07:30

Luvox and celexa are ok, but probably not likely to break TRD on their own. Luvox may be worth a shot, as it's mechanism is slightly different from SSRIs.

I found luvox was ok for sleep and anxiety, but not so much for depression. The sigma agonism of fluvoxamine could be useful if OCD or psychotic features were present (but it doesn't sound like this is the case).

I don't think that trintillex is super potent as an SSRI (at least in therapeutic doses), the idea being that it's action at other sites seems to provide a theraputic effect with less potent action as an SSRI.

I found escitalopram a better antidepresant than citalopram (marginally). It could be good to combine with something like bupropion. The norepinephrine active drugs supposedly are more effective if high inflamation is present.
I don't suppose your doctor is able to test for markers of inflammation (not standard practice, but perhaps informative)?

How is your blood glucose? Any prediabetes? Some studies show that drugs like piogitazone can augment standard antidepressants, even if glucose is marginally dysregulated. Pioglitazone is also a mild / moderate MAO-b inhibitor.

What about selegiline? I'm not sure how comfortable your doctor is, but supposedly it can be combined with SSRIs, at least in lower doses.
Have you ever used dextromethorphan? (you didn't respond well to ketamine, if I recall..). Dextromethorphan, combined with bupropion or quinidine, may be useful.

Celebrex may augment some antidepresants, again, if inflamation is high.

I still swear by pure cocoa powder and an anti-anhedonic strategy. Cocoa nibs are also useful. Also, as you know I've been trying medical marijuanna with relative sucess (more research is emerging on the use of cannabanoids for depression / anxiety). The cannabinoids THC and CBD are as potent at ppar-gamma receptors (action of pioglitazone) as they are at cb1 receptors.
Effexor and remeron do work very well together (apparently more effective than parnate for TRD) but the initial remeron sedation can be strong.

I did well with effexor, remeron and a bit of the herb "fo-ti" (mao-b inhibitor). I stopped taking the fo-ti for liver concerns, but it was very effective for reducing taking the edge off anhedonia.

Have you tried dopamine agonists (mirtapex is suppsedly effective for TR bipolar depression).
Mirapex might work well with trintillex (for a more broad spectrum receptor agonism profile).

There's some ideas, let me know if you want more.





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