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Re: nortriptyline+sertraline+methylphendate gman22

Posted by SLS on September 4, 2023, at 17:54:20

In reply to nortriptyline+sertraline+methylphendate, posted by gman22 on September 4, 2023, at 11:29:48

> Looking for feedback on this as a possible combination...Or if I take just two of them, which ones would be the best and safest to take long term.
> Thanks

I can't speak to the benefits of taking methyphenidate to produce a true antidepressant effect, even when used in combination with other medications. It most often gives someone more mental energy, but that seems to be more of a palliative measure than a therapeutic one. Have you read or heard of methylphenidate producing a true remission? I just haven"t personally seen miracles with it. If it helps palliatively onle, it makes sense to use it until you find an effective antidepressive treatment.

Your proposed combination of nortriptyline plus sertraline is well thought-out. The neurotransmitters that are inhibited by these two drugs are complementary. I know that most antidepressants have properties in addition to reuptake inhibition, but I don't know enough about them to put together a coherent explanation that includes them. At this point in history, scientists still struggle to put together a neurobiological explanation for the etioloogies of mood disorders. They are equally uncertain as to why certain substances work to treat them.

Research into the psychobiology of affective disorders is fascinating and stimulating. But for now, it is *clinical* research and the anecdotes of psychiatric practitioners that guide treatment. Clinical practice still relies more on observation than theory. I don't know everything regarding how the drugs that brought me to remission work. I just know that they do. My choices of drugs is very much based upon my treatment history and how I reacted to each drug I've tried along the way. Perhaps you can follow a similar line of thought.

These drug combinations have been observed to produce therapeutic results. It is meant to be an all-inclusive list.

- Sertraline + venlafaxine (or desvenlafaxine)
- Sertraline + bupropion
- Venlafaxine + bupropion

* Add LOW-dosage lithium to any regime (as long as mania is not a feature of your illness). I absolutely need lithium 150mg/day to produce remission. However, lithium 300 mg/day or higher produces a deterioration in my condition that is effectively a relapse.

* Add lamotrigine 150-300 mg/day to any treatment regime.

Over the years, my best responses have come from a MAOI + TCA combination. MAOI monotherapy has also produced positive results. Right now, the following four drugs are necessary to be used to produce remission:

Phenelzine (Nardil) - 90 mg/day
Nortriptyline (Pamelor) - 100 mg/day
Lamotrigine (Lamictal) - 300 mg/day
Lithium (Li2CO3) - 150 mg/day

A successful psychiatrist will confer with colleagues on a regular basis to exchange observations and experiences.

Fluoxetine (Prozac) is underutilized. This being the case, there isn't much clinical information regarding its use in polypharmacy. Fluoxetine generally produces more mental energy rather than fatigue or sedation. It also has a lower liability for weight-gain and a reduction in sex drive, although it might delay orgasm. Apathy is not seen as frequently or as robustly than with other SSRIs.

* Again, these are generalizations. If you line up 10 people, you might get 10 different reactions to the same drug.

Good luck.

- 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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