Shown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by smart.drug on May 13, 2008, at 3:58:59
Hey everyone,
Welcome to another episode of Medication Management, where you can help me out with my meds. Today, we're discussing core symtoms of dysthymia.
So basically, I have dysthymia with recurrent MDD. The problem is, when I go to my school pdoc, he's like, "You don't fit the criteria for dysthymia." No, I don't! 'Cause I'm "fine" when there's no stress. But I don't want to wait for the next episode of depression. If medication can help to prevent it, I'm all for it.
I think there are three basic things that I ought to do in any case. One is exercise--for obvious reasons, too numerous to list. Two, omega-3 (from fish, not flax.) Again, too many benefits, not very many side-effects. Okay, third thing is Deplin (methylfolate.) It's approved as an antidepressant augmentor, so maybe with the other two measures, it can be enough to prevent an episode of MDD, In any case, I doubt it can hurt. It probably impacts "core symptoms," without being sedating or stimulating, so it's fine with me.
Okay, moving onto meds. I have a few options in mind. Help me pick one, or just give me your feedback.
1.) Okay, we'll start with the simplest one. An SSRI with bupropion (or methylphenidate/ Adderall.) Pros: it's simple. Cons: The stimulants can make me lose sleep. I tried Lexapro, which gave me bad diarrhea and cramps. I hung tough for six weeks, but it never got any better. I give that other SSRI's have different profiles, but they scare me.
2.) Import reboxetine and tianeptine, and get my doc to prescribe selegiline 5 mg bid. Pros: I'm hitting all three neurotrasmitters, so the best chance of success. Cons: Money. I'm going to have to pay for the first two out of pocket. Also, my hope is that by hitting all three, I can avoid side-effects (brain lowers dopamine in response to SSRIs). But I might get a whole bunch!
3.) Selegiline 5 mg bid, DLPA, lithium 1 cap hs, and buspirone. Okay, this one looks crazy, so some explanations are in order. The selegiline is in the MAO-B selective range, so I can crank up the dopamine, while avoiding the tyramine reaction. D-Phenylalanine is converted to PEA, which selegiline can prevent from being destroyed. PEA is a stimulant antidepressant in its own right (when taken with selegiline.) The LPA will just be converted to dopamine, so I guess it won't hurt. To avoid an imbalance, I'm using the buspirone and lithium to increase serotogenic activity without getting into an SSRI. Some people get scared when they even look at the word lithium, but I doubt that at a dose that low (300 mg at bedtime), I'd see any side-effects. Also, lithium is used an an antidepressant augmentor in its own right. Of course, I'd do all the blood work and stuff.
Pros: sounds good. Cons: dunno if it'll work! And complicated, too.4.) Go for broke. Use 30 mg or more of selegiline, in the unselective dose range! Pros: No doubt it'll work! Cons: dietary restrictions, and won't be able to use stimulants if I need them.
The thought of EMSAM has crossed my mind, but my insurance benefits are limited; I can't afford it. I'm waiting for lastodigil to come out!
Anyway, I'm tired of having this dark cloud hang over me all the time. I'm ready to do something, and I'll make my doc listen! And I appreciate your help!
Posted by llurpsienoodle on May 13, 2008, at 10:38:41
In reply to Medication Management: Episode 2, posted by smart.drug on May 13, 2008, at 3:58:59
Hi smart drug,
welcome! I read your earlier thread too. So many options, so little time.Well... I am sorry that you have trouble when stress increases. That is a bad cycle to get into, because we overcommit ourselves and then it comes back, ferociously, to bite us in the *ss.
If you're having problems with sleep, but still need a stimulant, why not try modafinil (provigil). It didn't disrupt my sleep cycle.
I have also gotten relief from valerian tea.
And psychotherapy to help with the stress relief. You know- a good talk can change brain chemistry too :)
Sleep hygeine is important, but so are finals. Get through this and try not to be too self-destructive about it.
take good care,
-Ll
Posted by michael on May 13, 2008, at 14:32:20
In reply to Medication Management: Episode 2, posted by smart.drug on May 13, 2008, at 3:58:59
> Hey everyone,
>
> Welcome to another episode of Medication Management...>
> ...The thought of EMSAM has crossed my mind, but my insurance benefits are limited; I can't afford it. I'm waiting for lastodigil to come out!
Just wondering, what's lastodigil?
Posted by bleauberry on May 13, 2008, at 17:40:51
In reply to Medication Management: Episode 2, posted by smart.drug on May 13, 2008, at 3:58:59
I like the way you put so much thought into it. That being said, no matter how good of a job we do analyzing what would work and why, we actually have no clue if it would or not until actually tried. What looks perfect on paper can turn out to be worthless in realtime, and vica versa. I mean for example, if hitting all 3 neuros was so predictable, then everybody who tried nardil or parnate would get better. But that's not the way it works out. I've seen people here greatly improved or cured on things that they never considered and things that just didn't make any sense. And of course, on the other hand, there have been people with carefully thought out plans that got well on their plans. Sometimes not. There's just no predicting.
Posted by med_empowered on May 14, 2008, at 15:40:55
In reply to Re: Medication Management: Episode 2, posted by bleauberry on May 13, 2008, at 17:40:51
wow...that's some intense medicatin' your planning. I was just going to suggest maybe wellbutrin+sri, or maybe a low low dose of an antipsychotic, w. or w/o an antidepressant. Or BuSpar with the antidepressant of your choosing.
Good luck.
This is the end of the thread.
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