Posted by SLS on June 9, 2015, at 22:38:10
In reply to Re: CBT vs Seroquel or Abilify or Latuda » SLS, posted by legm82 on June 9, 2015, at 15:35:08
> > Nortriptyline by itself has been known to be effective as an antidepressant. In addition to NE reuptake inhibition, it also blocks 5-HT2a receptors, which might help make it less "harsh" than desipramine. Just about every antidepressant can induce a switch into mania, but the TCAs are considered particularly liable in this regard. How often do you experience hypomania? Is it spontaneous, or does it happen only in response to medication? Is it a mixed state with persistent depressive symptoms or irritability, or is it more pleasantly energizing with expansive thinking or delusions of grandeur?
> >
> > What has been your experience with MAOIs?
> >
> >
> > - Scott
> The hypomania I experience is with depressive symptoms and irritability, it's mostly induced by medication like antidepressants or stimulants.
>
> Do you consider nortriptyline to be better than doxepin or surmontil?
If you are prone to manic switches, most doctors would not suggest taking a tricylic without a mood stabilizer or anti-manic agent. Perhaps Seroquel? Of the TCAs, Surmontil makes an interesting choice. It is not a reuptake inhibitor and helps normalize sleep architecture. I don't know the extent to which mania is a liability with Surmontil. Perhaps it is lower. Doxepin is also an interesting choice for you. It is a potent antihistamine and will help with sleep. I have seen someone who suffered from bipolar depression with infrequent hypomanias do well with Nardil + doxepin. She had had a wonderful response to lithium monotherapy for quite a few years, but a new doctor had her discontinue it. She relapsed within a month. Restarting lithium did not help. She hasn't felt well since.In my experience, Depakote and Zyprexa have made the best "emergency" antimanic agents for me. My manias are severe and are triggered by medication. They have been infrequent. I think it has happened four times, all in association with MAOIs with and without TCAs.
By the way, my lithium blood level is at or below 0.4. It won't have antimanic properties at such a low level, but it can still exert antidepressant effects. Also, 150 mg/day of lithium will help prevent Alzheimer's Dementia. For me, 300 mg/day serves both functions, and is unlikely to affect thyroid or renal function. You can always have blood tests to monitor these. If I go higher in dosage with lithium, I experience flat affect and a feeling of greater depression.
- Scott
Some 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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