Posted by JohnL on March 8, 2001, at 17:03:04
In reply to Whats my next med option ??? Help please !!!, posted by ben on March 5, 2001, at 11:54:21
Ben,
Wow, I sure empathize with you. I've been in your shoes exactly, for way too long, so I can relate.When you say that maybe serotonin is not the only thing involved with your kind of depression, I tend to agree. The good news is that there are lots of options. The bad news as you know is that it so hard and so frustating to guess at each new drug only to find it's not what was hoped for. You sound strong though. Hang in there.
Since you could be sensitive to side effects, I would stay away from the tricyclics. One of them, like either Nortriptyline or Desipramine, could work very well for your, but I doubt the side effects would be agreeable with you.
The two chemistries most likely involved, as I see it, are noradrenaline and dopamine. The addition of 2.5mg Zyprexa, increased to 5mg in one to two weeks, could work magic. It has for a lot of people. The main drawbacks are early sedation, which DOES go away fairly soon, and weight gain, which tends to level off in time and can be counteracted by lifestyle choices in eating or exerting energy. Zyprexa seems to do real well for a whole wide variety of symptoms, including anhedonia and melancholia. This may because it does have mechanisms which affect both NE and dopamine in addition to serotonin.
Outside of your average mainstream pharmacy you could venture into the world of online pharmacies and try Adrafinil, Amisulpride, or both. Both together totally wiped out my longstanding anhedonia/melancholia. But so does Zyprexa+Prozac.
To narrow a long list of options down to a few, I would place my bets for you on Zyprexa, Risperdal, Amisulpride, Adrafinil. In a worst case scenario where none of them were helpful (I highly doubt that), then Ritalin or Adderal could be tried.
And it's worth mentioning not to rule out other SSRIs. There is usually one that stands out as being a strong favorite, but we would never know which one it was if we didn't try them and sample them for comparison.
Anyway, hope there are some ideas here that might help.
John
poster:JohnL
thread:55621
URL: http://www.dr-bob.org/babble/20010302/msgs/55948.html