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which ssri w/ lithium? new pDoc 5/1...


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Have moved to a new city.

will see a new pDoc on 5/1.

would like to explore Lithium.

which SSRI goes best with a side of Li?

(of course i'll consider a TCA...)

my probable dx, accd. to DSM-IV-TR:

A. Mood reactivity (i.e., mood brightens in response to actual or potential positive events)

B. At least two of the following:

Significant weight gain or increase in appetite ("comfort eating")[3]

Hypersomnia (sleeping too much, as opposed to the insomnia present in melancholic depression)

Leaden paralysis (i.e., heavy, leaden feelings in arms or legs)

Long-standing pattern of interpersonal rejection sensitivity (not limited to episodes of mood disturbance) that results in significant social or occupational impairment

C. Criteria are not met for Melancholic Depression or Catatonic Depression during the same episode.

atypical depression. I'm the poster child for all of the above.

Some Hx:

Fall 1999

I wanted to d/c light to moderate use of Delta-9 THC to elevate mood, concentrate on hygiene, motivate to clean house, exercise, etc.

so I saw my 1st pDoc.

Poss. DX: Cyclothimia

Serzone – neck pain

Neurontin - nothing

Wellbutrin – headaches

March 2000

new pDoc

Poss. DX: Substance use & Anxiety

Buspar – nothing

Remeron – ‘turned the light on’

Jan 2001

new pDoc - best of bunch

Poss. DX: ADD Depression

Remeron 45mg

Klonopin .5mg x 3 – effective

Ritalin – focus and attention to detail

2002

Concerta 54mg then adjusted to 36mg x 2

Far better delivery – no rise and fall

Period of wellbeing

May 2004

d/c Remeron – weight gain

start Topomax – significant weight loss

Jan 2005

start Lamictal as potentate– little effect

March 2005 - Mar 2006

*My 40th Birthday*

d/c Topomax

d/c Lamictal

Zoloft – hard to d/c

Effexor – hard to d/c

Strattera - nothing

Adderal – irritable, crashes, dependency potential

Lexapro - nothing

Wellbutrin – nothing, no headaches this time

Paxil CR – mild positive effect

July 2006

Health Insurance ends

Only Klonopin

Began Jogging

August 2006

back to THC – effective – undesirable side FX

Oct 2006

UCLA study

No meds, incl. THC

Horrible baseline

Dropped out w/ placebo in 3 weeks

Nov 2006

Restart Klonopin .5mg QID

Desipramine - nothing

Nortiptyline - mild improvement

Dec 2006

Nortiptyline

THC

Jogging 10 miles /week

Best Cardio Shape of my Life!!!

April 2007

Cymbalta 60mg

Dec 2007

new pDoc

Cymbalta 60mg

Neurontin 600mg X 3

Klonopin .5mg x 2

Now:

Klonopin .5mg x 2

Now that you have the story, what would Jung prescribe?

thanks!

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