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Re: Vortioxetine revisited at 20 mg

Posted by SLS on January 8, 2024, at 12:15:36

In reply to Re: Vortioxetine revisited at 20 mg SLS, posted by undopaminergic on January 7, 2024, at 10:13:06

Hi.

> I am the best psychopharmacologist I'm acquainted with...

I don't doubt that for a second - which is both fortunate and unfortunate.

I like lithium 300-600 mg/day based upon my personal experience. My therapeutic window (actually, therapeutic index) lies at exactly 300 mg/day. Changing the dosage by 150 mg/day up or down ruins the antidepressant response to my regime. The other reason to take lithium is to significantly reduce the risk of developing Alzheimer's Disease. 150 mg/day is way more than enough from what I've read.

Memantine produced no noticeable improvement for me. I'm pretty sure I used the maximum recommended dosage. My illness leaves me vulnerable to manic reactions to Nardil and Parnate when combined with a TCA. However, this has happened no more than a handful of times. In the 1990s, I was pounded with a Parnate-desipramine combination combined with amphetamine. At the moment, I don't recall adding methylphenidate to a MAOI-TCA combination, but I do recall taking it. I remember that it felt "harsher" than amphetamine. I also chose to add bromocriptine and pergolide (separately) to this combination, as both are DA receptor agonists. Both are available in the U.S. to treat Parkinson's Disease. I experienced a few days of relief before I relapsed. Did any of the DA receptor partial agonist antipsychotics have any positive effects on you at all?

I commend you on your current approach towards treatment. It will greatly increase the odds of your finding an effective treatment.

To reiterate the most fundamental principle in the treatment of depressive mood illnesses with a standard antidepressant, one must allow enough time to see a therapeutic improvement. It takes at least two weeks for the action of a drug to prompt a sufficient compensatory response by the brain to alter the dynamics of brain function. This can take between 2-12 weeks. That very much sucks.


A depiction explaining the latency between the beginning of treatment and the emergence of a therapeutic improvement might help to explain this. By the end of day one of treatment with a TCA or SRI, the drug is already blocking the presynaptic uptake transporter. Yet, there is no significant improvement seen on day 2. Why is that? In the 1980s, I encountered a great many medical journal articles suggesting that it took two weeks to see an appreciable compensatory reduction in NE beta receptor binding. It was also suggested that NE beta receptors had a turnover of two weeks. This suggests an explanation for the latency in treatment response.

How can one justify allowing every new treatment three months to work? The experience of even one day of depression can be tormenting. What about suffering for 84 consecutive days (12 weeks) without relief, and then having to start all over again with a new treatment regime? Repeated observations demonstrate that if there is absolutely no improvement by the end of 6 weeks of antidepressant treatment, it is unlikely that waiting another 6 weeks will help.

This is what is currently working for me:

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

1. Removing any one drug produces a relapse.
2. Changing the dosage of any one drug produces a deterioration or a relapse.


Suggestion:

1. Make a list of drugs that produced any improvement - regardless of how robust or how short-lived.
2. Make a list of drugs that produced a worsening of the condition being treated, regardless of side effects.
3. Make a list of drugs that had no effect at all on the condition being treated.
4. Make a list of drug combinations that had a positive effect, especially wherein monotherapy with either drug failed to produce an improvement.


All of the drugs that I am using in combination were chosen from list #1. This was my approach to choosing drugs to combine. As monotherapy, each drug from list #1 produced some improvement.

I guess that's all for now.


- 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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poster:SLS thread:1122281
URL: http://www.dr-bob.org/babble/20230117/msgs/1122301.html