Posted by papillon2 on August 19, 2012, at 7:07:36
In reply to Lamictal and also TCA's..., posted by AlexCanada on August 17, 2012, at 22:47:58
> Hi. Thanks for the suggestions. I have actually tried Lamictal this year... The ''Lamictal Stupid'' syndrome is well documented online and it's unfortunate that it has such an effect on me.
What was your Lamictal dose? Some people who experience cognitive impairment on Lamictal find it goes away on a lower dose. 200mg is considered the max therapeutic dose in Australia. Some people report cognitive problems over this amount.
> I am possibly willing to give pristiq a chance because I may not have given effexor enough time. The issue was worsening of dep and anxiety and it was during my darkest days and i probably felt like screaming if the doctors at the hospital had kept me on it. But... with my baseline a bit improved I could perhaps handle such a medication and attempt to give it a decent trial period. I mention Pristiq because articles keep mentioning that it is approved for Melancholic.
Oh, ok. I was wondering if each med had been given an adequate trial.
I had a 7-year partial-remission with Effexor, though my melancholic symptoms weren't as bad.
> Ketamine I have researched and unfortunately if it only lasts for 7-10 days then it is not something i'd want to look into just yet but i am glad they are putting new medications into trials which are based upon the ketamine research.
I was thinking Ketamine might give you an initial boost which could be sustained by other medications. Like what they do with ECT. I am only hypothesizing here, I don't know how it works in this regard. The researchers might not know either!
> Regarding TCA's... any cognitive side effects do they often go away if they deal with the core melancholic symptoms?
My cognitive symptoms improved on Nortriptyline with each dose increase. I have lingering problems, but I think this is from residual depression rather than the medication. I guess you'll only know if you try it.
> What can I expect in terms of TCA's generally? such as maybe clomipramine? I don't remember what happened with nortripline.
I don't know enough about clomipramine to comment on it.
With TCAs you can generally expect a more robust anti-depressant effect. It's older, rougher medication, so unfortunately you can also expect worse anti-chlorinergic side effects than those that come with SSRIs or SNRIs. For me, some of the side effects abated within one month of each dose increase while others persisted. Your mileage may vary.
TCAs are also much more likely to be lethal in overdose than SSRIs/SNRIs. If suicidal ideation is a problem, you can ask your doctor to prescribe the medication such that the pharmacist will only give you a limited supply at a time.
> I have tried lithium before, it may have been with paxil. it didn't seem to do much of anything and i believe i felt more sluggish. possibly my dose was too high. i don't remember.
Finding the right dose is really important with Lithium. I was a complete zombie when my blood serum level was .8. (my psychiatrist was aiming for .4 but forgot to take my weight into account, sound familiar?!).
> The lithium... do you recommend it on it's own (with valium + ritalin) or as an add-on to an anti-dep?
For treatment-resistant depression Lithium is usually an add-on to an anti-depressant. It has a synergistic effect. I don't know how it interacts with Ritalin.
I am unable to weigh in on some of your other comments/questions, e.g. whether there is a med which will increase your level of interest in things like Lamictal did without the cognitive problems. I just don't have the knowledge or experience, but someone else might.
Take care,
PapillonRing the bells that still can ring
forget your perfect offering
there is a crack in everything
that's how the light gets in
~ Leonard Cohen
poster:papillon2
thread:1023380
URL: http://www.dr-bob.org/babble/20120818/msgs/1023650.html