Posted by SLS on August 27, 2009, at 6:39:58
In reply to question(s) for SLS, posted by g_g_g_unit on August 26, 2009, at 22:34:30
Hi.
Well. Where do we start with you? Ruling out SRIs and TCAs leave us with Remeron, mianserin, Wellbutrin, reboxetine, and maprotiline, and MAOIs as traditional antidepressants. Have you tried desipramine or reboxetine? As you know, desipramine is a TCA that works on NE, but doesn't touch serotonin. Reboxetine does the same thing as desipramine, but is not a TCA. I will state here that, although some people do respond to reboxetine, this seems to be a small minority. For some people, it does nothing more than produce anxiety or even worsen depression. Desipramine, on the other hand, has established itself over a great many years to be clearly effective.
Lamictal is often a very "clean" drug cognitively. It has a habit of affecting short term memory somewhat, but nothing that becomes impairing. For those cases that do experience cognitive side effects, they can be significant. However, one can try to reduce the dosage to try to find the lowest effective dose. For me, going to 300mg really messes me up. Then, at 200mg, my mind clears and I preserve the response. Lamictal is a drug that likes to tease people. You can feel a real improvement early in treatment with dosages as low as 50mg. Then the improvement disappears. It can then reappear upon dosage increases, but it doesn't "stick" until you arrive at a higher dosage threshold. Lamictal can also produce an improvement upon dosage reductions, which fools many people thinking that a lower dosage (below the threshold) is better than a higher dosage. Of course, the individual loses this temporary improvement and either stays there hoping it will return, or go even lower.
Depakote can exert antidepressant effect for a sizeable number of people, but usually for those who have bipolar disorder, perhaps bes for bipolar II. However, some people also experience a worsening of depression, but it is usually a mild to moderate worsening. It is worth trying this drug, in my estimation. Depakote is more likely to produce cognitive side effects than Lamictal. You just never know until you try. I experienced none at dosages as high as 3000mg. Any mental fog that appears early in treatment often disappears with time. I didn't gain any weight or lose any hair, but these things are possible with Depakote.
Trileptal is another mood stabilizer to look into. It is probably as effective as Tegretol, its sister drug, but is a lot cleaner with respect to cognitive side effects and the risk of blood cell abnormalities.
I had a mild improvement of depression with Topamax. I had no cognitive impairments with this drug, although it has a reputation as producing more than the other drugs, leading to its nickname of Dopamax. I found it cleaner than Lamictal. However, I started at a low dosage and raised it very gradually to only 100mg. This was done purposely as to avoid triggering cognitive impairments. It seems that if you don't trigger them by going up in dosage too fast, you can avoid getting them at all.
My titration schedule for Topamax.
Week 1 25 mg
Week 2 50 mg
Week 3 75 mg
Week 4 100 mgAlthough not traditional mood stabilizers, atypical antipsychotics can have antidepressant effects and prevent mania. Doctors are looking more and more at Geodon. Seroquel is actually approved by the US FDA for use in bipolar depression. Many people here have good luck with Abilify.
You do have alternatives.
What happens to you when you take TCA, SSRI, and SNRI?
- Scott
poster:SLS
thread:914289
URL: http://www.dr-bob.org/babble/20090826/msgs/914320.html