Posted by desolationrower on May 20, 2009, at 13:20:26
In reply to Re: Appt with new pdoc Thursday--preparation? » desolationrower, posted by Amelia_in_StPaul on May 19, 2009, at 12:07:13
> hey d/r!! thanks for the welcome back. poor house, indeed. feels a little like living a charles dickens novel, crashing against the tides of forces beyond myself. when will my long-gone rich relations make an appearance to save me from the poor house? um, I hope you've read much dickens. otherwise, I'm babbling. ;-)
ha, i read dickens in high school, never again. he babbles far too much :) actually i don't like much from 19thc, maybe dostoyevksi. between the romantics and wilde, nothing....
> okay, here's the landscape I was thinking of in terms of meds:
>
> Memantine, in combo with something else?hm. while its pretty low in side effects, its not really a 'proven' antidepressant. but might help OCD. I might leave that aside, although perhaps you want to mention it as something to try later on, so your doc isn't totally surprised next time you do ask for it.
Have you gotten NAC yet? I might try that before the memantine.
As far as excess/insufficient glutamate, i don't know theres a clear syndrome for each. THe excitotoxicity is related to excess phasic glutamate, not the basal level.
> Provigil, to counter SSRI fatigue and help with ADD?
could be helpful. it is $, i forget your insurance quality?
> Drugs low on the antimuscarinic scale
>
> Luvoxit sounds like you've tried a few ssris, and fluoxetine works the best. i probably would stick with it, at least at a low dose.
> Sleep drug with shorter half-life (Doxepin? would like to avoid Remeron, as I ate half a grocery
> aisle of junk food in the time I was on it)that will probably be the case with any antihistamine. so i think gabapentin might be a good choice for sleep.
> Last ditch effort--add an atypical AP like Abilify or very low dose Risperdal
>
> Not anafranil or other TCAs that are metabolized by 2D6--my intermediate metabolization means I could be at greater risk, I think, for heart effects (trying to avoid early fatal heart attacks rampant in family)it would just mean you would need a lower dose than some other people. theres plasma monitoring for levels with tcas. And intermediate is only a bit less than normal. i don't think this is a risk to worry about. so i still think nortryptaline would be the best thing to try; both to improve energy, apathy, etc, and to improve slow wave sleep. it has a bit more anticholinergic properties than desipramine (though low compared to other TCAs), but it has 5ht2 antagonism which improves sleep quality.
> Guanfacine (not sure about it--I have orthostatic hypotension already)
yeah. its complicated treating anger/apathy and low energy at the same time. probably not a first choice.
> Lamictal
probably worth trying. it isn't fatiguing generally. some evidence for it in ptsd too.
> An AD I haven't tried--Pristiq? Or?
>
> ----
>
> It's a fuzzy-headed list, but it's a start I guess. I just know that I can't stand the apathy that occurs once I'm ramped up on fluoxetine. Kills my spirit.i'd suggest only taking as much as you need to keep ocd/anxiety stuff at bay, and finding something else (non-sri) to most of the mood correction.
I guess the thing i'm not sure of, is what symptoms are you needing help with the most?
> Good to hear from you. How are you?
>last month not good, but last week has been better.
-d/r
poster:desolationrower
thread:896538
URL: http://www.dr-bob.org/babble/20090515/msgs/896828.html