Posted by LouisianaSportsman on April 4, 2014, at 22:37:37
In reply to What do I do about this leftover depression?, posted by phidippus on March 27, 2014, at 19:48:44
Lithium 1200 mg
Lexapro 20 mg
Geodon 160 mg
Vyvanse 70 mg
*DEPRESSION IS UNTREATED*I know you have tried a plethora of medications. Well, at this point, it seems that you might need to try a MAOI; obviously, that would remove the Vyvanse therapy which I know is an effective medication for you. Dont be alarmed as your ADHD can be managed using other stimulatory management.
This leaves use with:
Lithium 1200 mg
Lexapro 20 mg
Geodon 160 mgYes, I believe we should add an a MAOI; however, I believe it may be good to augment your Lexapro with an agent. Have you considered cabergoline (Dostinex)?
http://www.ncbi.nlm.nih.gov/pubmed/20526584 Cabergoline, a dopamine receptor agonist, has an antidepressant-like property and enhances brain-derived neurotrophic factor signaling. Cabergoline exerts antidepressant- and anxiolytic-like effects, which may be mediated by potentiation of intracellular signaling of BDNF.
http://journals.lww.com/clinicalneuropharm/Abstract/2003/09000/Addition_of_a_Dopamine_Agonist,_Cabergoline,_to_a.5.aspx We present herein 2 patients with depression who showed dramatic improvement of treatment-refractory energy loss, fatigue, and lack of motivation when a dopamine agonist, cabergoline was added to a serotonin-noradrenalin reuptake inhibitor (SNRI), milnacipran.There are also other dopamine agonists, but I feel like you may have tried them already? Also, ignore the dosages suggested. I think it is worth a shot.
I feel like youve already tried so many things that I would suggest. I have lots of other strategies, but I feel they are not appropriate for you since you're a veteran.
I dont think that pindolol would hurt anything as well.
http://www.ncbi.nlm.nih.gov/pubmed/15006431 Once-daily high-dose pindolol for SSRI-refractory depression. In addition, results reported here suggest that a single high dose of pindolol (7.5 mg) is a more effective augmentation strategy in SSRI-refractory patients compared with the same total dose given at 2.5 mg tid.Now we have:
Lithium 1,200 mg
Lexapro 20 mg
Geodon 160 mg
Cabergoline 2mg.
Pindolol 7.5mg.
Nardil 75mg.Nardil is obviously the MAOI I suggest for you. You may still need to augment, however.
I suggest adding trimipramine (Surmontil) H1 antagonism + 5HT2A antagonism + alpha 1 antagonism that might help the excess NE issues with more NE then going to alpha 2 which can inhibit NE. I think there might be some literature on this combo too. This TCA looks smooth with Nardil.
Lyrica (or gabapentin) is an AMAZING choice. I cant rave about it enough. Definitely a mood brightener. But, I found I ran out of my maxed out script early and ended up paying two people to go get scripts for me and was taking 1,200-2,400mg. of Lyrica a day. I also had connections to get samples. So, I dont really suggest it too much. My PDOC knows about this so I am only prescribed the weak form, gabapentin at a measly 1,200mg./day. I still chose that script over the Xanax XR and Klonopin script so that definitely tells you how much I like it.
Also consider looking at T3. And too bad buprenorphine couldn't be an option for TRD...
Try this out:
Nardil 75mg.
Geodon 160mg.
Lexapro 20mg.
Lithobid 1,200mg.
Cabergoline 2mg.
Pindolol 7.5mg.
Surmontil 100mg.
poster:LouisianaSportsman
thread:1063319
URL: http://www.dr-bob.org/babble/20140328/msgs/1063685.html