Posted by SLS on October 15, 2016, at 17:25:47
In reply to Doctor thinks I need a phenylpiperazine? Help!?, posted by SouthernFarmer on October 14, 2016, at 18:14:30
> Rexulti 3mg
> Aplenzin 348mg
> Nuvigil 150mg
> Belsomra 10mg
> Gralise 1,800mg
> Klonopin 2mg twice a day
> Desipramine 150mg
> Deplin (l-methylfolate) 15mg
> Lamictal ER 100mg
What is the Klonopin and Gralise for?What is the Nuvigil for?
How do you know that Deplin is still providing relief?
Belsomra and Nuvigil might antagonize one another with respect to the orexin system.
I have seen only a few people profit long-term to Mirapex. Are you sure that it is really helping? If energy is a problem, you might do better to use Vyvanse or Focalin. However, if Mirapex is producing unambiguous improvements in anhedonia, it is probably worth keeping. I'm not a big fan of DA pure agonists, though. I'm not sure why. I guess I don't like seeing dopamine receptors downregulated.
I hope you don't get too angry with me: Even though I'm a big proponent of polypharmacy, I can't help but to think that your treatment regime has become a bit messy. My concern is that you might be experiencing cognitive impairments that manifest as brain-fog or a "zombie" effect that are preventing you from increasing the dosages of some drugs; Lamictal and desipramine in particular.
I have just a few comments, although they might not be relevant in your case:
1. The dosage of Rexulti is rather high to treat depression. It might be blunting your affect or giving you brain-fog. 2.0 mg/day should be enough in most cases.
2. The dosage of desipramine is low. If you can tolerate it, you might consider going to 200-300 mg/day.
3. You might try switching from desipramine to nortriptyline. It is milder with respect to side effects, and not as much of a problem with respect to sexual function.
4. Brintellix is a serotonin drug that is known to enhance cognition and should not produce brain-fog. I don't think sexual side effects are a problem.
5. Lamictal dosage is lower than what most people need to glean its full antidepressant potential - 200 mg/day. How long did you stay at 150 mg/day before returning to 100 mg/day? I found that the "zombie" effect or brain fog was only temporary.
I have seen bupropion + lamotrigine + aripiprazole work very well with someone who has unipolar depression and someone else with schizoaffective disorder with depression. Prior to discovering which drugs were working, they had been on very complicated treatment regimes.
I have been fortunate in that my doctor and I have both contributed to a treatment that seems to be working. I have worked with each drug separately to determine its necessity and the lowest effective dosage. Reducing the dosage of any one drug causes me to deteriorate. Going any higher in dosage of some drugs produces unnecessary side effects without further benefit.
- 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:1092616
URL: http://www.dr-bob.org/babble/20160928/msgs/1092628.html