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Dr. Bob is Robert Hsiung, MD,
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Posted by SLS on July 11, 2016, at 16:16:30
In reply to Re: Best AD for Melancholia » SLS, posted by brynb on July 11, 2016, at 15:29:42
> > Ruminations and intrusive thoughts are known to be symptoms of melancholic depression. If true OCD is comorbid with melancholic depression, clomipramine (Anafranil) is a drug to explore.
>
> Can Anafranil be added to my current 20mg of Lexarpro?Theoretically, serotonin syndrome can be a complication of this combination. How much is the Lexapro helping?
> 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.
> > I've had partial success with adding nortriptyline to a SNRI.
> For melancholic depression, OCD or both?I have bipolar depression without OCD.
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.
You might think to add memantine for OCD if you get stuck.
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.
- Scott
Posted by jonhed on July 11, 2016, at 17:02:05
In reply to Re: Best AD for Melancholia » brynb, posted by SLS on July 11, 2016, at 16:16:30
I agree, and if the OCD is present i would highly recommend memantine.
I feel hell lot of difference with it, in case of my ocd.
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
Posted by brynb on July 11, 2016, at 17:50:11
In reply to Re: Best AD for Melancholia, posted by jonhed on July 11, 2016, at 17:02:05
> I agree, and if the OCD is present i would highly recommend memantine.
> I feel hell lot of difference with it, in case of my ocd.Does it help with your depression too?
Thanks!
Posted by jonhed on July 12, 2016, at 3:30:12
In reply to Re: Best AD for Melancholia » jonhed, posted by brynb on July 11, 2016, at 17:50:11
In fact i have no idea.
I have to be honest with you, and this is why the doctors always says "we take one change in a time", cause i don't know if it's just the methadone that act like an antidepressant or if memantine is too.I can describe my feeling of memantine, and that is that you are like in a "fuzz" and i feel very nurtured when i take it. You know, like being a little in your own bubble?
I can concentrate very easy and nothing feels like it is a pain in the *ss to do (like doing the dishes).
And this is in the evening when i take the memantine and the initial wakefulness of methadone has faded long ago, so yeah i think it is antidepressant.
especially when you take subutex to, i think that would be to a great combo as with methadone, since both is opioids, and memantine seem to synergize or potentiate opioids (i haven't decided which of them there is yet).
And some last words about what i think.
If my OCD is under control, it has to have AD properties to, but i can't be sure.It is off label but not for long (my pdoc is, for real, very famous here in sweden and says that in maybe 1-2 years there will be a lot more indications written in the, what you now call it).
Kind regards, i hope you find what you're looking for.
Posted by jonhed on July 12, 2016, at 5:09:25
In reply to Re: Best AD for Melancholia, posted by jonhed on July 12, 2016, at 3:30:12
are you french or swedish?
If i may ask.
Posted by brynb on July 12, 2016, at 5:20:26
In reply to Re: Best AD for Melancholia, posted by jonhed on July 12, 2016, at 5:09:25
> are you french or swedish?
> If i may ask.hi,
American, actually.
thanks again for your input; i'll post an update after seeing my doc today.
-b
Posted by jonhed on July 12, 2016, at 5:32:11
In reply to Re: Best AD for Melancholia » jonhed, posted by brynb on July 12, 2016, at 5:20:26
Thanks, do that :-)
Keep memantine in mind, cause it doesn't have nearly no side effects. It has like 18 side effects which all are not serious, so it can't hurt you so to speak :-)
Posted by jonhed on July 12, 2016, at 5:32:51
In reply to Re: Best AD for Melancholia, posted by jonhed on July 12, 2016, at 5:32:11
none* is serious.
Posted by jonhed on July 12, 2016, at 5:34:13
In reply to Re: Best AD for Melancholia » jonhed, posted by brynb on July 12, 2016, at 5:20:26
I was asking because you used the name "subutex", and that is common in sweden and france :-)
just so you don't think i thought you speak bad english hehe
Posted by brynb on July 12, 2016, at 8:36:52
In reply to Re: Best AD for Melancholia, posted by jonhed on July 12, 2016, at 5:34:13
> I was asking because you used the name "subutex", and that is common in sweden and france :-)
>
> just so you don't think i thought you speak bad english heheno worries =)! I take subutex because suboxone has naloxone in it (subutex is strictly buprenorphine) and naloxone makes me ill/gives me side effects.
i see my pdoc today and will be discussing a lot of options including suggestions in this thread.
thanks again for your help!
Posted by jonhed on July 12, 2016, at 11:45:45
In reply to Re: Best AD for Melancholia » jonhed, posted by brynb on July 12, 2016, at 8:36:52
Yeah, it makes you sick instead of making you sound. (suboxone)
Good luck today :-)
Posted by brynb on July 12, 2016, at 14:07:49
In reply to Re: Best AD for Melancholia » brynb, posted by SLS on July 11, 2016, at 16:16:30
Thanks everyone for your input.
I met w/my pdoc this morning and we decided to add a low dose of Desipramine to my existing cocktail (Lexapro 20mg, Subutex and Klonopin 2mg).
We decided it's the easiest tweak right now rather than dropping Lexapro and or adding Anafranil, which may carry too many SEs to start and apparently is quite expensive (I already pay out of pocket for Subutex which is $165/monthly). We'll see if it addresses the melancholia and that it would be the easiest/most gentle addition and the only new variable.I'm hoping that this addition will brighten my mood enough to treat/target the melancholia and in turn serve as a catalyst to my practicing some non-med options (meditating, exercising, etc.) to address my OCD-like thoughts and overall mental health.
I'd also like to keep my med cocktail simple.
SLS, you mentioned Anafranil has a huge success rate, and after an easy search, it's apparently miraculous for OCD and depression, rated very highly in reviews. Unfortunately, as you mentioned, it carries A LOT of side effects. As I'm currently functioning, I feel like I can hold off on a major med change like that for now.
Thanks again and I'll keep everyone posted. Hope you're all feeling well =).
-b
Posted by jonhed on July 13, 2016, at 15:19:07
In reply to Update--Re: Best AD for Melancholia, posted by brynb on July 12, 2016, at 14:07:49
I think that was a good choice, desipramine, klonopin, subutex and lexapro = sounds like it could work.
Some up, some down and some calm, that should be it :-)I have thought about desipramine a lot and if you want to share how it is working for you, i'll be thrilled to hear from you :-)
Best wishes from me / J
(I've been on anafranil, and it has an awful lot of side effects, mainly anticholinergic, so desipramine was a good choice i think)
Posted by Phillipa on July 13, 2016, at 22:51:13
In reply to Update--Re: Best AD for Melancholia, posted by brynb on July 12, 2016, at 14:07:49
Try low dose lexapro & low dose luvox, and the benzos. Been on for years and what's this about your pup? Phillipa
Posted by brynb on July 14, 2016, at 0:30:54
In reply to Re: Update--Re: Best AD for Melancholia, posted by jonhed on July 13, 2016, at 15:19:07
Thank you! I will certainly update everyone on the combination.
Hope you're doing well, jonhed =). All the best!
Posted by brynb on July 14, 2016, at 0:31:01
In reply to Re: Update--Re: Best AD for Melancholia, posted by jonhed on July 13, 2016, at 15:19:07
Thank you! I will certainly update everyone on the combination.
Hope you're doing well, jonhed =). All the best!
Posted by brynb on July 14, 2016, at 0:31:05
In reply to Re: Update--Re: Best AD for Melancholia, posted by jonhed on July 13, 2016, at 15:19:07
Thank you! I will certainly update everyone on the combination.
Hope you're doing well, jonhed =). All the best!
Posted by brynb on July 14, 2016, at 0:35:26
In reply to Re: Update--Re: Best AD for Melancholia » brynb, posted by Phillipa on July 13, 2016, at 22:51:13
> Try low dose lexapro & low dose luvox, and the benzos. Been on for years and what's this about your pup? Phillipa
Hi Phillipa!
She's ok (thank G-d), I just get these OCD-like thoughts about my parents, my dog, my loved ones getting sick or worse. I ruminate a lot about death but I think it's because I can't handle the concept of death/loss/nothingness =(.
How are you my friend?
Posted by SLS on July 14, 2016, at 6:47:16
In reply to Re: Update--Re: Best AD for Melancholia » Phillipa, posted by brynb on July 14, 2016, at 0:35:26
> She's ok (thank G-d), I just get these OCD-like thoughts
I don't think true OCD matches the thought pattern you describe. You should research the differences between OCD and rumination. I wouldn't mention OCD if your you display ruminations only. It might confuse both you and your doctors in choosing treatments.
I don't know.
- Scott
Posted by Phillipa on July 14, 2016, at 9:34:14
In reply to Re: Update--Re: Best AD for Melancholia » Phillipa, posted by brynb on July 14, 2016, at 0:35:26
Brynn my thoughts all the time but switch the thoughts to myself as older now and the pups and trying to keep up with a younger husband. I'm finding the older I get the less meds I need. Must be all the bike riding in the heat. Just moved into the new home. Love Phillipa
Posted by brynb on July 16, 2016, at 18:08:33
In reply to Re: Update--Re: Best AD for Melancholia » brynb, posted by SLS on July 14, 2016, at 6:47:16
> > She's ok (thank G-d), I just get these OCD-like thoughts
>
> I don't think true OCD matches the thought pattern you describe. You should research the differences between OCD and rumination. I wouldn't mention OCD if your you display ruminations only. It might confuse both you and your doctors in choosing treatments.
>
> I don't know.I don't either. I don't know enough about OCD and/or its differences compared to rumination. I do act compulsively by calling my loved ones a lot/excessively and running home constantly to check on my dog. I also have horrible/violent thoughts about loved ones NOT because I want them to happen but because I fear them. I'll follow up more w/ my pdoc during our next visit in a few weeks.
On the bright side, in the short time I've added Desipramine to my Lexapro (and other 2 meds), I've already noticed an improvement in my mood and some quieting of my mind. I don't know if it can happen that quickly, but I'm surprised. I am tired and nauseous, but I'll ride out the SEs for now with the hopes that they'll subside and the med will continue to work.
-b
Posted by brynb on July 16, 2016, at 18:11:10
In reply to Re: Update--Re: Best AD for Melancholia » brynb, posted by Phillipa on July 14, 2016, at 9:34:14
> Brynn my thoughts all the time but switch the thoughts to myself as older now and the pups and trying to keep up with a younger husband. I'm finding the older I get the less meds I need. Must be all the bike riding in the heat. Just moved into the new home. Love Phillipa
Glad to hear you need less meds now. And congrats on your new home! Very exciting.
Much love.
Posted by Ruuudy on July 17, 2016, at 10:34:55
In reply to Re: Update--Re: Best AD for Melancholia » brynb, posted by Phillipa on July 13, 2016, at 22:51:13
> Try low dose lexapro & low dose luvox, and the benzos. Been on for years and what's this about your pup? Phillipa
Phillipa,
Are you currently taking those two SSRI's together? Conventional teaching would have you believe that taking two SSRI's simultaneously would be discouraged - I would argue that because each SSRI can have slight differences on which receptors they affect, they can still work together better than just one SSRI. Very curious to read your answer!Thanks!
Rudy
Posted by Ruuudy on July 17, 2016, at 10:40:22
In reply to Re: Update--Re: Best AD for Melancholia » Phillipa, posted by brynb on July 14, 2016, at 0:35:26
> > Try low dose lexapro & low dose luvox, and the benzos. Been on for years and what's this about your pup? Phillipa
>
> Hi Phillipa!
>
> She's ok (thank G-d), I just get these OCD-like thoughts about my parents, my dog, my loved ones getting sick or worse. I ruminate a lot about death but I think it's because I can't handle the concept of death/loss/nothingness =(.
>Howdy brynb,
I think you & others will find this report I just read very encouraging that researches might be onto something very promising for better, quicker-acting medicines in the near future!https://www.sciencedaily.com/releases/2016/07/160715140751.htm
Rudy
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