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Re: Linkadge medication linkadge

Posted by SLS on December 5, 2022, at 23:17:22

In reply to Re: Linkadge medication, posted by linkadge on December 5, 2022, at 14:13:52

> I'm still doing well with what I am taking. The lithium + mirtazapine + ritalin seems to be working fairly well.
> The ritalin helps me *want* to get better.
> Linkadge

I guess you're on the right track - or at least one of several right tracks.

Can you commit to performing a trial of this combination lasting 6-8 weeks without changing a single thing? Wouldn't this be a novel approach for you compared to most of what you have done over the last 22 years?

Different is different.

I think the following treatment has a better chance of working for Linkadge than what he has chosen as his current trial to treat a depressive disorder. Perhaps the core treatment around which to build an effective treatment can be considered the combination of nortriptyline + lithium. I think that Wellbutrin demonstrated any improvement at all makes it eligible as an adjunct. That's 3 agents that have an established history of treating depression successfully, and are indicated by the FDA for that purpose. Methylphenidate is a stimulant that serves to make you feel better and function better, but is it a true augmenter for you? I don't think so. What is the goal of using an adjunct or augmenter? What is the role that an augmenter plays? Can a drug be labeled an augmenter if it doesn't potentiate the therapeutic effect of the drugs they meant to augment? I don't see how a drug can be an augmenter of a treatment if it doesn't increase the magnitude of the therapeutic response being targeted.

1. Nortriptyline
2. Wellbutrin
3. Lithium

4. Methylphenidate

5. Lamotrigine (?)

From what little I know about the pharmacology of these drugs, I thought their mechanisms of action would be more complementary than redundant. Methylphenidate? Why not? It helps Linkadge keep his head above water. Why not take it, even if it has absolutely no capacity to bring about a robust antidepressant response, or complete remission. Anything that helps get someone get through the day that doesn't interfere with the processes being effected by their trials of antidepressants makes sense to me. If an effective palliative treatment allows the affected individual to be able to run a trial to its completion, it is no less essential to achieve the goal than the antidepressants themselves.

Beware: I have no letters appended to my last name. It is possible that I am way wrong. Perhaps others can critique my suggestion?

- Scott

Some see things as they are and ask why.
I dream of things that never were and ask why not.

The only thing necessary for the triumph of evil is that good men do nothing.




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