Psycho-Babble Medication Thread 1007711

Shown: posts 1 to 16 of 16. This is the beginning of the thread.

 

suggestions

Posted by g_g_g_unit on January 18, 2012, at 20:12:13

Hey, so my psychiatrist's finally back from vacation. Things have been kind of up-and-down. I withdrew completely from Valium in order to assess the effect that 20mg of Lexapro is having.

It's strange - I find that 6-7 hours of sleep will leave me relatively wired-yet-tired; I'm more alert but somewhat cracked out. It's not really possible to sustain this for more than 2-3 days, however, because I'll become too physically drained.

On the other hand, sleeping 8+ hours will leave me more calm and physically rested but incredibly spacey, foggy and anhedonic; since I have ADD, my reading comprehension etc. is already rather fragile and it just becomes impossible to think, read, concentrate on the SSRI alone. Coffee helps, but increases my anxiety during withdrawal.

I'd be willing to increase the Lexapro, but only if it's likely that a stimulant would offset the cognitive side-effects because I find this limbo-like state just as depressing as depression itself. Last time I tried adding Dexedrine to 15mg of Lexapro, it still increased my anxiety too much. I felt fine on the combination of Lexapro, Valium and Dexedrine but don't feel Valium did my cognition any favors either.

I've also consulted with Dr Ken Gilman, who runs the psychotropical site, out of interest. His recommendation is 50-60mg of Parnate, which he believes might potentially treat the depression, anhedonia, OCD and could help ADD as well.

For the record, I have also yet to try Effexor, Pristiq or Cymbalta.

 

Re: suggestions

Posted by bleauberry on January 19, 2012, at 5:15:03

In reply to suggestions, posted by g_g_g_unit on January 18, 2012, at 20:12:13

I agree with Gilman.

Other than that, I would personally have about zero faith in lexapro. It would stand a chance if it had a norepinephrine counterpart in the mix with it, such as nortriptyline, desipramine, ritalin, or milnacipran. That strategy is also from Gilman.

 

Re: suggestions g_g_g_unit

Posted by SLS on January 19, 2012, at 6:42:35

In reply to suggestions, posted by g_g_g_unit on January 18, 2012, at 20:12:13

> I've also consulted with Dr Ken Gilman, who runs the psychotropical site, out of interest. His recommendation is 50-60mg of Parnate, which he believes might potentially treat the depression, anhedonia, OCD and could help ADD as well.

This is all true. Nardil is probably better with OCD, though.

I would not stop increasing the Parnate until you reach a dosage of 80 mg if that becomes necessary. I don't think the dosage range for Parnate as recommended in the PDR is sufficiently high. 40 mg seems to be the minimum dosage at which people respond well to.

There is a high-dosage Parnate treatment strategy that works sometimes when the normal dosages do not. The minimum dosage for this treatment is 120 mg.


- Scott

 

Re: suggestions bleauberry

Posted by Phillipa on January 19, 2012, at 10:12:11

In reply to Re: suggestions, posted by bleauberry on January 19, 2012, at 5:15:03

And poster here worked on me for years to use lexapro. Sorry I hyjacked :( Phillipa

 

Re: suggestions g_g_g_unit

Posted by phidippus on January 19, 2012, at 13:50:31

In reply to suggestions, posted by g_g_g_unit on January 18, 2012, at 20:12:13

Its time you jumped up to the 40 mg dose of Lexapro.

Have you tried Vyvanse? Of all the stimulants I have been on Vyvanse has little or no risk of increasing anxiety.

You can go with Dexamphetamine 15 mg and counter the anxiety with Ativan, which I don't think you've tried.

Eric
ps. Parnate is a good choice, but won't addequately treat the ADHD.

 

Re: suggestions

Posted by jono_in_adelaide on January 19, 2012, at 16:19:59

In reply to suggestions, posted by g_g_g_unit on January 18, 2012, at 20:12:13

A few thoughts

1/ You have nothing to lose by trying Parnate, and everything to gain, so why not do it

2/ Have you tried bupropion (Welbutrin) combined with an SSRI? You can buy it from America at reasonable cost from www.internationalpharmacy.com

3/ Have you tried adding Nortriptyline 75mg at night to your SSRI?

4/ Have you considered "californian rocket fuel" - Effexor 150mg in the morning, and Avanza/Remeron 30mg at night

 

Re: suggestions SLS

Posted by g_g_g_unit on January 19, 2012, at 22:20:48

In reply to Re: suggestions g_g_g_unit, posted by SLS on January 19, 2012, at 6:42:35


> I would not stop increasing the Parnate until you reach a dosage of 80 mg if that becomes necessary. I don't think the dosage range for Parnate as recommended in the PDR is sufficiently high. 40 mg seems to be the minimum dosage at which people respond well to.
>
> There is a high-dosage Parnate treatment strategy that works sometimes when the normal dosages do not. The minimum dosage for this treatment is 120 mg.
>

I met with my psychiatrist today. He wants me to withdraw from Lexapro in preparation for a Parnate trial.

I told him I was concerned about the Australian prescribing regulations, which list a recommended dose of 20mg (with anything above 30mg requiring strict supervision). But he consulted Stahl's prescribing guide, which lists a maximum dose of 60mg - in accordance with American prescribing guidelines, I gather?

I'm not sure he'd go above 60mg, but I should thankful that he's at least being flexible.

I admit I am hesitant about returning to Parnate, since last time, on a maximum dose of 40mg, I generally felt *more* depressed and dysphoric, but I'm wondering if a higher dose will make a difference.

 

Re: suggestions phidippus

Posted by g_g_g_unit on January 19, 2012, at 22:34:48

In reply to Re: suggestions g_g_g_unit, posted by phidippus on January 19, 2012, at 13:50:31

> Its time you jumped up to the 40 mg dose of Lexapro.
>
> Have you tried Vyvanse? Of all the stimulants I have been on Vyvanse has little or no risk of increasing anxiety.

No, Vyvanse isn't available in Australia sadly.
>
> You can go with Dexamphetamine 15 mg and counter the anxiety with Ativan, which I don't think you've tried.

Yeah, my psychiatrist doesn't like using Ativan. Do you feel it's less likely to affect cognition?

>
> Eric
> ps. Parnate is a good choice, but won't addequately treat the ADHD.
>

Ah .. you seem to prefer a more tailored approach to meds, so didn't think you'd really go for an MAOI. I'm not looking for complete remission from ADHD; I'd mostly just like a med that doesn't cause brain fog or adversely affect my reading comprehension.

 

Re: suggestions jono_in_adelaide

Posted by g_g_g_unit on January 19, 2012, at 22:43:11

In reply to Re: suggestions, posted by jono_in_adelaide on January 19, 2012, at 16:19:59

> A few thoughts
>
> 1/ You have nothing to lose by trying Parnate, and everything to gain, so why not do it

You're right. I feel bad for my psych though, so just dread failing another trial. I know that's not a healthy way to view the therapeutic relationship, but ..
>
> 2/ Have you tried bupropion (Welbutrin) combined with an SSRI? You can buy it from America at reasonable cost from www.internationalpharmacy.com

No I haven't tried bupropion.

>
> 3/ Have you tried adding Nortriptyline 75mg at night to your SSRI?

What benefits would Nortriptyline have in combination with an SSRI?
>
> 4/ Have you considered "californian rocket fuel" - Effexor 150mg in the morning, and Avanza/Remeron 30mg at night

No, my psychiatrist generally prefers using Effexor as a last resort. Maybe if things don't work out with Parnate .. though I still am really torn over whether I should just stay on an SRI and augment.

I described the sleep problem I was having, where I'll feel anxious and wired after 7-8 hours sleep and somnolent and inattentive after 8-10 hours. I've noticed the same thing on all the SSRIs I've tried so far. My psychiatrist thinks it's a problem with my diurnal circadian rhythm, so I don't know if there's any way to ameliorate it ..?

 

Re: suggestions

Posted by jono_in_adelaide on January 19, 2012, at 23:56:26

In reply to Re: suggestions jono_in_adelaide, posted by g_g_g_unit on January 19, 2012, at 22:43:11

Nortriptyline + an SSRI hits both noradrenalin and seretonin, can give the 1-2 knockout punch to depression, it also has some effect at the 5HT2 receptor, so can reduce anxiety.

You could try melatonin to help with the sleep rythem thing....cheaply avaliable from the US, try Vitacost.com

Bupropion hits noradrenalin and dopamine, can realy help the anhedonia and poor concentration.

For me, the combo of an SSRi with any of the NARI's (reboxetine, nortriptyline, bupropion) worked well - I'm currently taking sertraline + rebxetine because it is avaliable localy and is easy to take.

Dont be afraid to use Valium or another benzo when you need it, the risks have been blown out of all proportion in the popular media, even if you do become dependant, you just need to taper slowly when its time to stop.

 

Re: suggestions g_g_g_unit

Posted by phidippus on January 20, 2012, at 14:13:11

In reply to Re: suggestions phidippus, posted by g_g_g_unit on January 19, 2012, at 22:34:48

If you have ADHD there's little more than you can do...

ERic

 

Re: suggestions phidippus

Posted by g_g_g_unit on January 20, 2012, at 18:58:30

In reply to Re: suggestions g_g_g_unit, posted by phidippus on January 20, 2012, at 14:13:11

> If you have ADHD there's little more than you can do...
>
> ERic

Sorry, wasn't sure what you meant by this?

 

Re: suggestions g_g_g_unit

Posted by phidippus on January 21, 2012, at 15:32:48

In reply to Re: suggestions phidippus, posted by g_g_g_unit on January 20, 2012, at 18:58:30

ADHD meds:

Methylphenidate
Concerta
Adderal
dextroamphetamine
Vyvanse
Ritalin
Straterra

off label:

Wellbutrin
Focalin
Modafanil/Provigil
Nuvigil
Memantine

Eric

 

Re: suggestions phidippus

Posted by SLS on January 21, 2012, at 15:51:09

In reply to Re: suggestions g_g_g_unit, posted by phidippus on January 21, 2012, at 15:32:48

Desipramine


- Scott

 

Re: suggestions SLS

Posted by phidippus on January 23, 2012, at 13:38:33

In reply to Re: suggestions phidippus, posted by SLS on January 21, 2012, at 15:51:09

Desipramine for what?

Eric

 

Re: suggestions phidippus

Posted by SLS on January 23, 2012, at 14:28:18

In reply to Re: suggestions SLS, posted by phidippus on January 23, 2012, at 13:38:33

> Desipramine for what?


ADHD.


- Scott


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