Posted by SLS on June 16, 2015, at 15:30:02
In reply to Re: Desipramine Questions » SLS, posted by busub on June 16, 2015, at 14:34:22
Would you be willing to try Nardil? It seems like the next logical step as a follow-up to desipramine and nortriptyline trials. Nardil is particularly well suited for treating a combination of GAD and depression.
Reuptake inhibitors might be too harsh for you, although Viibryd might be worth a try.
I am getting the impression that Latuda (lurasidone) isn't good for very much when it comes to depression. Abilify would be better, but akathisia-like side effects are often problematic. 2.5 mg/day seems to be the most common dosage used when combined with antidepressants.
Paxil is the one drug that stands out for not working the second time around. It is the worst offender. I wish you had visited this website sooner. :-( Conversely, TCAs are probably the least likely to "poop-out". Given your history, do not ever stop taking an effective treatment. This goes for Nardil, too.
I would consider adding a small amount of lithium (300 mg/day) as an augmenter for depression only.
I don't see Lamictal (lamotrigine) on your list. I know it has a good reputation for treating bipolar depression, but I see people with unipolar depression use it as an augmenter at 200 mg/day. A combination of Lamictal and Abilify works magic for some people. As you know, it takes about a month to titrate Lamictal to a therapeutic dosage. You might consider starting Abilify at 1.0 mg (half a 2.0 mg pill) every other day. It has a long half life (72 hours), so taking it on alternate days will work well. Since you are not in a rush, you can increase the dose gradually if necessary. Perhaps go to 1.0 mg every day, then alternate days at 1.0 mg and 2.0 mg. If you reach 2.0 mg/day without akathisia, that's great. If you develop intolerable akathisia dosing Abilify at 1.0 every other day, I doubt it will be of much use. However, mild akathisia can disappear entirely. It did with me. Just be prepared for some moderate insomnia at first.
If you cannot establish Abilify, try adding N-acetylcystein (NAC) with or without minocycline. Sounds weird, I know, but together, these drugs modulate glutamate neurotransmission and suppress brain inflammation.
Just a few ideas...There are more ideas to be suggested by other posters on Psycho-Babble, so hang in there.
- 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
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