What combo to try next?

[Alpam]

Hi all, I am finding my current cocktail isn't really working and I don't know what to ask for next.

I have MDD, GAD, ADD, Insomnia, and I am constantly fatigued.

Previous meds:

Zoloft 200mg - didn't notice any change

Mirtazapine 45mg - side effects nearly ruined my life, didn't notice any improvement

Dothiepin 300mg - Worked well for 3-4 months then pooped out

Temazepam - no effect noticed even in larger doses

Current meds:

Cymbalta 60mg - been on it about 3 months worked okay for the 4th - 5th week then wasn't so effective

Seroquel 50mg - The only thing that will get me to sleep at night

Dexamphetamine 30mg - been on it almost 4 weeks now, last week I had 5 days where I was feeling the best I ever had, now feeling like crap.

Valium 20mg - I 'think' it's helping with the GAD, have not had a panic attack since I started on it a year ago. It also helps with the anxiety the Dex causes.

I am starting to get my really bad anxiety back again, not quite a panic attack, but damn close, also my mood is dropping more and more every day. I don't think the current meds are working but I don't know what to ask for, maybe something else to augument what I have.

Reboxetine(NRI)? or would that be too much norepinephrine?

Xanax? but my anxiety is constant 24/7 and xanax has a short half life.

SSRI? Zoloft did nothing for me and can it be combined with a SNRI?

TCA? From what I have read TCA's can have contridictions with the dex and Cymbalta

MAOI? My doc is reluctant to go down that path, plus then I would have to give up the dex.

Seroquel? I could ask for an increase in dose but I am already tired enough through the day I don't want to be any more tired.

Any ideas, suggestions are welcome, I just want to find something that will make me feel at ease for once.

[null0trooper]

1. Maybe cut back on the Cymbalta for a few weeks and see if the anxiety abates some? The dextroamphetamine should be sure to release noradrenaline, and the Cymbalta should be keeping it in circulation, ideally it would leave a person feeling a bit on edge all the time. Cutting down on the Cymbalta should allow the NA levels to drop more (and the cognitive effects of the dex then won't last as long... it's all trade-offs)

2. Since elevated NA is usually associated with increased anxiety, irritability, insomnia, and over time fatigue from all of the above, I think I would hesitate to add Edronax to your current combination. When those symptoms aren't a big problem, there are folks on a Wellbutrin/Cymbalta combination who do okay. Going the other direction with serotonin could work if you don't add too much/too strong an SSRI.

3. A TCA can usually be combined with a stimulant, with adjusted dosages. It depends on the exact TCA as to whether it will do any good. Some TCAs are strong antihistamines, some are selective for serotonin reuptake inhibition, others for noradrenaline, a few affect nearly every transmitter, and one or two have AAP effects (those could be the strong antihistamines/sleep meds)

4. An MAOI can be combined with a stimulant, IF the dosages are low and watched carefully. An MAOI plus Cymbalta could be really bad, probably at any dose.

5. It's possible that a phenylalanine or tyrosine amino acid supplement might help (more meat in the diet might be better, but that has its own risks as well)

So what non-pharmaceutical things have you looked into for getting some of your energy back - diet, exercise, sleep hygiene?

[Alpam]

When I was just on the Cymbalta I didn't feel on edge or anymore tired (or awake for that matter), and since starting on the Dexamphetamine, apart from the first couple of weeks, I have been sleeping a lot deeper and longer than I was before.

I have always suffered from lack of energy and have been tired all of the time. My mother told me when I was a kid she took me to doctors, naturopaths, dieticians as she was worried because I was so tired all of the time, all of them said it was just a part of growing, well I am all grown up and still the same. Lately I have been to a sleep clinic which didn't find anything wrong. Lately I have been eating well, exercising (probably should do more though) I am not overweight I was taking multi-vitamins every day till I started on the Dex. If I get less than 10 hours sleep a night I am a complete wreck the next day, living zombie, at the moment I get 11 hours sleep on weeknights, about 12 on weekends.

I think I might ask to drop the Cymbalta altogether, can only get 60mg doses here and Wellbutrin is not available. I have no idea what to ask for next though. I might give those supplements a go too, and I eat meat every day of the week.

[null0trooper]

When I was just on the Cymbalta I didn't feel on edge or anymore tired (or awake for that matter), and since starting on the Dexamphetamine, apart from the first couple of weeks, I have been sleeping a lot deeper and longer than I was before.

I don't sleep longer (*that* would be difficult) but I do sleep much better when I take my Adderall on schedule.

I have always suffered from lack of energy and have been tired all of the time.If I get less than 10 hours sleep a night I am a complete wreck the next day, living zombie, at the moment I get 11 hours sleep on weeknights, about 12 on weekends.

It might be that you just need more sleep than the average person. It's not great, but there are worse things a person could have to deal with in life.