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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by phidippus on March 27, 2014, at 19:48:44
I'm on
Lithium 1200 mg
Lexapro 20 mg
Geodon 160 mg
Vyvanse 70 mgI am treating
ADHD
Bipolar I
OCDThe only symptom I am having is depression. What can I add to get my mood up to par?
Eric
Posted by Christ_empowered on March 27, 2014, at 20:44:07
In reply to What do I do about this leftover depression?, posted by phidippus on March 27, 2014, at 19:48:44
maybe mid-afternoon Dexedrine tablet?
Posted by enndub on March 28, 2014, at 13:58:49
In reply to What do I do about this leftover depression?, posted by phidippus on March 27, 2014, at 19:48:44
Drop everything but the lithium and go on Parnate? Depression is much more debilitating than ADD in my experience.
Posted by SLS on March 28, 2014, at 17:08:26
In reply to Re: What do I do about this leftover depression?, posted by enndub on March 28, 2014, at 13:58:49
> Drop everything but the lithium and go on Parnate? Depression is much more debilitating than ADD in my experience.
That's an interesting idea.
What about the OCD? I have heard of Nardil being helpful to treat it, but not Parnate. This might be an artifact of bias in study designs, though. Nardil has been chosen to study more often than Parnate. However, I would probably choose Parnate first, as it is usually more forgiving with regard to side effects. There is no reason why amphetamine or methylphenidate could not be employed in conjunction with a MAOI. Desipramine and nortriptyline can be used as well.
- Scott
Posted by tom2228 on March 29, 2014, at 14:45:36
In reply to Re: What do I do about this leftover depression?, posted by SLS on March 28, 2014, at 17:08:26
> > Drop everything but the lithium and go on Parnate? Depression is much more debilitating than ADD in my experience.
>
> That's an interesting idea.
>
> What about the OCD? I have heard of Nardil being helpful to treat it, but not Parnate. This might be an artifact of bias in study designs, though. Nardil has been chosen to study more often than Parnate. However, I would probably choose Parnate first, as it is usually more forgiving with regard to side effects. There is no reason why amphetamine or methylphenidate could not be employed in conjunction with a MAOI. Desipramine and nortriptyline can be used as well.
>
>
> - ScottSay that to my new pdoc, whose best defense against the slew of literature I brought her validating the safety of (selected) TCAs with MAOIs was "You can find literature for everything."
On a week wash-out from Marplan and starting notriptyline on Monday. I know it takes more time to adjust but not sure I like being off an MAOI at this point. I was able to fill a refill for Marplan so I have about 4 months' worth if I were to resume it at 20mg with the nortrip and without her knowledge.
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.
Posted by phidippus on April 5, 2014, at 15:45:24
In reply to Re: What do I do about this leftover depression?, posted by LouisianaSportsman on April 4, 2014, at 22:37:37
The problem is now mood stabilization, not depression. Lexapro is destabilizing my mood.
Eric
This is the end of the thread.
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