Posted by SLS on March 12, 2014, at 20:59:14
In reply to Re: Phidippus. - I see. My apologies., posted by phidippus on March 11, 2014, at 11:49:05
Thank you for your consideration of my situation. You ask all the right questions. Your ideas are great.
> > My childhood sucked. It was full of parental physical and emotional abuse - that is, when I wasn't being totally neglected.
> Has borderline personality disorder ever been discussed as a possible diagnosis for you?It was never offered as a diagnosis. I am sure that it was screened for, as I have had several psychometric evaluations, including the MMPI at the NIH (National Institutes of Health). The NIH was quite rigorous in their examinations.
> My childhood sucked because of peer abuse and neglect. I had trouble socially well into highschoolPerhaps prazosin would help you as it does me.
> My most severe depressive episode occured in 1999 when I had my first mixed bipolar episode.
That sucks.
> The depression was acute, had psychotic features, including cotard syndrome (I thought I was dead). On top of the bipolar symptoms I had severe OCD symptoms-persistent thoughts of harming others.
That really sucks.
> What was your depression like at age 17?
Gray and melancholic. Anergic. Moderate GAD. Severe social anxiety. Irritable. Somewhat paranoid. Moderate loss of interest and motivation. Moderately impaired reading and memory. Anhedonia (I get no pleasure out of saying that).
> What's strange is that I get my mania, ADHD and OCD under control and all I'm left with is a gnawing depression, which I am only now trying to treat.
I'm sure you'll figure it out.
> I feel sad and empty. I feel hopeless. I feel this anxiety like everyrthing is wrong. I feel guilty that I haven't become more successful. I lose interest in things that usually bring me joy. I have difficulty concentrating. I sleep too much or too little. I eat less. I have thoughts of hurting myself.
I have been plagued by most of those things at different times.
> > Parnate 100 mg/day
> I wonder if the Parnate is adequate.I tried 120 mg/day recently and 150 mg/day a number of years ago, both times in conjunction with TCA. Neither trial produced robust improvements.
> I wonder if you'd have a more robust response to Atomoxetine, which also happens to be an NMDA antagonist.
I tried atomoxetine, but had no luck with it.
> What's the point of 450 mg of Lithium?
It helps with depression and might act as a prophylactic against contracting Alzheimer's Dementia.
> You're probably reaping more side effects than benefits.
No side effects at all. (Maybe a little electrical discharge from time to time).
> Why not double the Lamictal and drop the Lithium or vice versa?
At 400 mg/day of Lamictal, I can't remember my own name. When I go above 450 mg/day of lithium, I experience amotivation and apathy along with having diarrhea.
> > prazosin 25 mg/day
> (in theory) raises dopamine (DA) levels in the synaptic cleft in the prefrontal cortex and inhibiting extracellular DA concentrations in the nucleus accumbens
That's interesting. How does that work?
> How is this helpful to you?It feels like a very clean antidepressant. My doctor thought of this in response to my descriptions of childhood.
> > minocycline 200 mg/day
> What does this do?Biologically, a whole bunch of things.
http://www.dr-bob.org/babble/20120803/msgs/1023257.html
Clinically, it feels like an antidepressant.
> > Abilify 10 mg/day
> Why not Geodon instead? Geodon has a far more sophisticated mechanism of action.Perhaps, but:
1. Parnate plus serotonin reuptake inhibition will likely precipitate serotonin syndrome.
2. It might be the DA D2/D3 receptor partial agonism that is important with my response to Abilify. It also antagonizes 5-HT7 receptors, but not to the same extent as Latuda.
3. I tried Geodon at 40 - 80 mg/day. I experienced a profound cognitive dulling (brain-fog) along with some derealization.
> > This regime is tweaked in that each drug has demonstrated its value by attempting its discontinuation.
> How odd. I take medication based on whether it makes me feel better or not, not because I feel worse because I stop taking it.If I have been on a particular drug for a long time, especially after other agents have been introduced, I will sometimes back off the dosage of that drug to see whether it is still contributing to my improvement, and what dosage is optimal in a new treatment structure.
> > Dosages have been optimized by careful titration. Dosages have been pushed and reduced as necessary.
> I push my medications to the highest dose then reduce to taste.
> Have you tried Rilutek?For me, it was an expensive placebo. Memantine was without effect, but I only went up to 20 mg/day.
> > I was never to respond robustly to treatment again.
> I think you're on too many drugs.
One is one too many.
> There's gotta be a way to simplify your regimen.
That's why I will try to discontinue a specific drug from time to time. I might try d/c the prazosin so that I can recover my sex-drive. I am hoping that the subsequent addition of minocycline will allow for this. I doubt it, though.
> Why not try Parnate and Desipramine again?
I originally responded to Parnate 60 mg/day + desipramine 150 mg/day. The combination never worked again. I have tried Parnate 60 - 150 mg/day + desipramine 200 - 300 mg/day.
Now that really, REALLY sucks.
- Scott
Some see things as they are and ask why.
I dream of things that never were and ask why not.- George Bernard Shaw
poster:SLS
thread:1062167
URL: http://www.dr-bob.org/babble/20140307/msgs/1062378.html