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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 3 of 3. This is the beginning of the thread.
Posted by ChrisK on May 5, 2001, at 6:34:59
Scott,
I see in a thread above that you are thinking of adding Effexor or Nardil to your Nortiptyline. I've been taking Nortriptlyine for many years now (lost track). The two things that have helped most as far as augmentation strategies have been Zyprexa and now Mirapex. I don't know what symptoms you are hoping to overcome but have you considered these?
While Nortriptyline helped with my general depression problems it took Zyprexa to overcome the ruminating thoughts. Now since I have been taking Mirapex since the first of the year I have overcome a lot of apathy and anhedonia. I'm actually back working part time and enjoying aspects of life that had left me a long time ago.
BTW, I just remembered that I switched from Zyprexa to Geodon last month for a 3 month trial. So far I don't notice any big difference in the two. I think that my pdoc might be a little more comfortable with the long term profile of Geodon.
Anyway, just curious about considering Effexor before these augmentors.
Chris
Posted by SLS on May 5, 2001, at 10:34:47
In reply to Question For SLS, posted by ChrisK on May 5, 2001, at 6:34:59
> Scott,
>
> I see in a thread above that you are thinking of adding Effexor or Nardil to your Nortiptyline. I've been taking Nortriptlyine for many years now (lost track). The two things that have helped most as far as augmentation strategies have been Zyprexa and now Mirapex. I don't know what symptoms you are hoping to overcome but have you considered these?The features of my case (bipolar depression) include anergia, psychomotor retardation, impaired memory, impaired cognitive skills (reading, learning, remembering), anhedonia, lack of motivation, slowed thinking, social anxiety and social inhibition, lack of libido, moderate hypersomnia, and moderate hyperphagia/carbohydrate cravings. It is very atypical-like and without rumination.
Both of your ideas are great and figure prominently on my doctor's list. I am now beginning to discontinue Parnate. I will have a better idea as to in which direction we would like to head after I see what I am left with after the wash-out period.
Earlier this year, we experimented with adding Risperdal and Zyprexa to the regime I was being treated with: Parnate 80mg, desipramine 300mg, and Lamictal 300mg. Both exerted a mild antidepressant effect that tended to wane after about a week. I would have wanted to continue with them. Unfortunately, trying to raise the dosage of either drug produced for me a mind-numbing cloud with cognitive blunting. I felt distant from everything and could not learn new things. I was unable to take more than 1.0mg of Risperdal and 2.5 mg of Zyprexa. I am hoping that these things were the result of some interaction with the Parnate. I would be very upset if this phenomenon were to occur with all neuroleptics. I had hoped to try Geodon, but I may hold off on that until a replacement for Parnate is established.
> Anyway, just curious about considering Effexor before these augmenters.
For now, nothing is set in stone. I will bring up both Geodon and Mirapex again when I see my doctor next. I think he is working with the impression that the severity and chronicity of my case indicates the need for another antidepressant. However, he is not committed to this. If I do move in that direction, I am going to have a difficult time choosing between Effexor and Nardil. Both have managed to "tickle" my brain in a positive way in the past. Nardil has given me a mild, but stable improvement in the past. I like the way it feels. I also liked the way Effexor made me feel, although it was not steady. I seemed to experience an improvement from changing the dosage - up OR down - that lasted for a day or so. I have not added anything to Effexor, and have added only desipramine as an augmenter to Nardil. I want to keep nortriptyline because it does more for me than does desipramine.
Do you have any thoughts regarding the choice between Effexor and Nardil? I don't consider the difficulty of discontinuing Effexor to be very relevant. The whole idea is that this not be necessary.
> While Nortriptyline helped with my general depression problems it took Zyprexa to overcome the ruminating thoughts. Now since I have been taking Mirapex since the first of the year I have overcome a lot of apathy and anhedonia. I'm actually back working part time and enjoying aspects of life that had left me a long time ago.
:-) That's GREAT! That is so cool. :-)
Thanks for taking the time to describe your experience with these drugs. Your drug combination looks more appealing to me now.
> BTW, I just remembered that I switched from Zyprexa to Geodon last month for a 3 month trial. So far I don't notice any big difference in the two. I think that my pdoc might be a little more comfortable with the long term profile of Geodon.
What is it about Geodon that your doctor feels more comfortable with?
It is so nice to watch someone finally hit the target and emerge from their mire of pain and constraint. I am so happy for you.
It means a lot to me that you should show concern for me. Thank you.
Sincerely,
Scott
Posted by ChrisK on May 6, 2001, at 6:54:10
In reply to Re: Question For SLS, posted by SLS on May 5, 2001, at 10:34:47
Scott,
Sorry to hear that you have so many complicated symptoms in your depression. While mine was very deep (two suicide attempts landed me in ICU for a total of 5 days) I only had a few symptoms to combat. I really don't know what can help with your cognitive problems. It seems like everything I've taken seem to deteriorate that thinking. Right now my short term memory is completely shot. I forget things that happened 5 minutes ago.
On the other hand Mirapex has been a Godsend for my anhedonia. Dr. Goldberg has a depression questionaire on his site and my average score dropped ten points after starting Mirapex (anything more than five is considered a significant change).
As far as the Geodon is concerned although he didn't say it I think that Zyprexa still has the reputation for causing TD long term and he may feel more comfortable with Geodon. He's given samples to a number of his patients and got the usual reaction to any new med. Some think it's great and some can't tolerate the side efffects. I've always been pretty med resistant so I rarely get side effects to the point of not being able to tolerate the med itself.
As far as Effexor and Nardil go - I have never taken an MAOI, always held them as a last resort. I did take Effexor for about 5 or 6 months two years ago. I was just coming out of an alcohol rehab and was completely sober at the time. I had barely any reaction to it. I was still taking Zyprexa at the time and that was sort of carrying me. I also tried Remeron during that period and it made me feel more dead than alive.
I had gone through a lot of med trials and asked to go back to a TCA because I had tried Immiprimine in the past and my father was a life long amitriptyline taker. That's when he gave me the Nortriptyline and I finally found some relief from the depression.
I tried Risperdal for a while but I had the zombie reaction to it. I didn't feel one emotion and it was a terrible feeling. I actually found it better to be depressed than to feel nothing.
I'm a big fan of finding something that helps some and then trying to augment it. If you've had meds that have "tickled" your brain a little I would go back and try to augment them. I know you read this board thoroughly so you know best the options that sound like they may work for you.
Thanks for the encouraging words. It's a different world for me these days actually having some motivation to do things. I still hang around Babbleland so that I can tell some people that there is hope. Three years ago I was in a psychiatric hospital for three different stays and two of those followed suicide attempts. Today I can work again and visit with family without having panic attacks. I can go to the golf course and enjoy a round of golf and I can enjoy the Kentucky Derby again. It's a life that I didn't think I would find. Hopefully I can give it back to someone else here who needs the encouragement.Best of luck to you,
Chris
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