Posted by SLS on July 22, 2016, at 16:49:08
In reply to Relapse of depression while on Nardil - SLS plz., posted by zonked on July 22, 2016, at 12:32:17
> Scott, I call upon you (and others) when I'm in dire straights. 90mg Nardil, 0.75mg Klonopin, 5mg ambien and 3mg melatonin for a mostly unsatisfying sleep.
If you can get the depression under control, then it will be worth being more aggressive in treating the insomnia.
> I know what this is. It's been longer than two weeks now - very little energy, lots of anxiety, little concentration, going through the motions, even seeing my family wasn't pleasurable. Nor would winning the lottery.
>
> Anhedonia.
>
> Psychology (I'm immersed in it, really) isn't helping me much. Here we go with the no, exercise isn't helping, opposite action isn't helping - those things all help when I'm at a decent baseline. They become inaccessible during a relapse of major depression.
>
> I was recently re-assessed for ADHD and no longer meet criteria. I am frustrated.
>
> I know a stimulant (in this case, Focalin XR) would provide the boost I need. I have tried other things and am too terrified to try antipsychotics. It's going to stay that way. Not interested in ECT.I don't think that it is yet time to consider ECT.
For depression, several people I know have used Focalin with greater success than Ritalin or Concerta. I used it briefly with some good effect. I was not responsive to other stimulants.
I have always had more success with MAOI + TCA (desipramine or nortriptyline) than with either one alone. For unipolar depression, you can try adding low-dose lithium (300-600 mg/day). If it is going to help, you will know rather quickly (3-14 days).
What is the downside of asking for treatment alternatives that your doctors might be resistant to prescribing? If he refuses to prescribe any drug for off-label use, it might be time to see someone else. In the meantime, you can start your discussion of using Focalin by telling him that you fully understand that he, as a doctor, would have concerns regarding addiction. However, ...
Although adding Focalin to Parnate or Nardil helps me with anergia and cognition, it does not help with the any other aspect of depression. By comparison, nortriptyline produces a true antidepressant response that manifests as a global in improvement.
What you might consider is to add nortriptyline to Nardil now, and switch from Nardil to a SNRI like Effexor or Cymbalta. You could then add Wellbutrin.
Nardil
Add low-dose lithium
Add nortriptyline
D/C Nardil
Start Effexor
Add Wellbutrin
D/C Wellbutrin
D/C nortriptylilne
Add RemeronAlternately, you can swap out Nardil for Parnate now, and then add low-dose lithium and/or TCA.
Based upon my personal experience, I would add lithium to Nardil first, and then add nortriptyline if necessary. Start at the lowest possible dosage and increase gradually. You might want to start taking it at bed time to prevent daytime somnolence. Your dosage will probably be 75-150 mg/day. You can have blood-tests performed to help guide you. The blood level of nortriptyline should be 50-150 ng/ml. If you go over 150 ng/ml, you might actually lose the response. This is called a therapeutic window, and is unique among the TCAs.
Eventually, you might need to attack insomnia more aggressively. Don't let insomnia be the thing that makes you give up on an effective treatment.
- ScottSome 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:1090732
URL: http://www.dr-bob.org/babble/20160713/msgs/1090739.html