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Awaiting ECT, but my cocktail meanwhile seems ineffective (surprise surprise!)


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As the title says, I'm awaiting ECT—my pdoc has to find a pdoc who can cover all of my sessions and not just some and who will just hand my brain over to another doctor. She would do it herself, but she doesn't have the time in her schedule to do it anymore like she used to, all she'd have time for would be the first treatment, and then she'd have to hand me over to someone else. Her go-to guy in my area isn't covered by my insurance, so she's searching for some candidates (she wanted to talk to them herself, I guess to see if they were able to "handle" me or something? lol)

Anyway, she switched up my cocktail a bit, which seemed to help a little at first, but I am quickly declining back into the dark, bottomless pit again and beginning to feel the tearful episodes wanting to return again, and I don't want to go back to the crying mess I was a few weeks ago.

You can see my cocktail in my signature, but I'll go ahead and post it here:

  • Fetzima 120 mg q AM
  • Dexedrine 15 mg 2 q AM (30 mg)
  • Latuda 40 mg q PM /w food
  • Zonegran 100 mg 1 q AM + 2 qhs (300 mg)
  • Niravam (alprazolam ODT) 2 mg qd prn
  • Deplin 15 mg q AM

I had some ideas that I'd like to run by you guys and see what you think, but I'd also like you guys' input as well for anything I might not have thought about.

  • Add Wellbutrin (I have to be careful about this one, I've taken it in the past for quite a while actually, and it eventually started giving me strange tremors and possible seizures)
  • Switch Fetzima out for...
    • Duloxetine (Cymbalta) (which I've taken before at doses up to 90 mg) — at least 120 mg, possibly 160 mg (120 mg + 40 mg, I'm a rapid CYP1A2 and CYP2D6 metabolizer)
    • Imipramine (Tofranil) (never taken before, I figure based on my experience with nortriptyline, I could start at 50 mg and work up to 150 mg, going up to 200-300 mg if needed, weight gain a concern)
    • Desipramine (Norpramin) (never taken before, dosages I figure would be the same as imipramine, even though I know the pharmacology is totally different, and that it's the major metabolite of imipramine, weight gain a concern but I hear it's not as bad as the other TCAs)
    • Clomipramine (Anafranil) (never taken before, figure I'd do the typical 25-100 mg for the first two weeks, and then if need be, titrate anywhere between there and the max of 250 mg afterward, weight gain a concern)
    • Protriptyline (Vivactil) (I've taken this before, the anticholinergic effects were a bit much for me to handle, but I'd be willing to tolerate them short term—I took it at only 30 mg/day before, but I figured given the severity of my depression, I could ask my pdoc to push the dose up to the max of 60 mg/day, weight gain a concern)
    • (Amitriptyline (Elavil)) (never taken before, and really would rather not due to the weight gain and anticholinergic side effects, but dosages would probably be the same as imipramine and desipramine, weight gain a major concern)
    • (Fluoxetine (Prozac) ) (I've taken this before a number of times, but gained weight gain with it. I only took 20 mg, so I figure 40-80 mg would be in order to try if I gave it another chance.)
  • Swap Latuda out for...
    • Seroquel XR eventually get to 300 mg (never taken this before out of fear of weight gain)
    • Rexulti start 0.5 mg, eventually get to 2 mg (taken before, actually made me more depressed and flat, but would be willing to give another try, also made me gain weight rapidly, but could've been my med configuration at the time also)
    • Abilify start 2-5 mg, eventually get to 10-15 mg? (did great with this for a while, but got nightmarish akathisia at 15 mg, but I think I went up too quickly is all, I was able to lose quite a bit of weight on this one so weight gain is not a concern for me)
    • (Risperdal low dose (like 0.5-1 mg/day?)) (never taken before, heard it's good for depression in low doses for some people, weight and man-boob concern)
    • (Zyprexa ~5 mg?) (never taken before, definitely concerned about this one as I just got my A1c from 5.8% (prediabetic) to 5.0%, and don't want to risk diabetes, nor do I want to risk weight gain, which I understand this one is a high risk for, but I've also heard it kicks depression's ass)
  • Switch Dexedrine for...
    • Desoxyn (taken before, was very mellowing and had very positive mood effects, which I know isn't the main reason to take a stimulant, but I'm in a desperate situation here.)
  • Add Lamictal? (taken before, discontinued due to adverse side effects, but I could tolerate them for a little while until I start ECT)
  • Add lithium? (I've heard low doses, even as low as 150 mg/day and up to 450-900 mg/day, are effective for depression. I've asked my pdoc about lithium several times but she doesn't seem to be too keen on the idea of lithium for me.)
  • Add Nuvigil 250 mg (I've taken this before, has moderate benefits for depression and ADHD. I've taken Provigil up to 400 mg and it does nothing for me.)

As you can see, I don't care how complicated my medicine regimen has to get, just as long as I don't go down into the pits again. I've even asked my pdoc about riluzole, and she's admitted that she's unfamiliar with prescribing it and wouldn't feel comfortable with prescribing it for me.

Is there anything I haven't thought of? Are there any ideas you guys have that I could bring up? I'd be willing to revisit something from my past as long as it was effective for me or didn't have adverse effects or anything, but if it's listed in my signature as "mixed," or "bad" experience, more than likely I'm not going to want to revisit it. Any help and suggestions would be much appreciated. Sorry for the long post. Thanks in advance for your time reading this.

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Keep in mind that none of us are doctors and we can't tell you what to do.

Antidepressants have never done much for me for depression though they do help with anxiety. So I'm not a big believer in the efficacy of antidepressants. The backbone of my cocktail is carbamazepine (Tegretol). While I can't say it makes me "undepressed," it does keep me out of the pit and also it shuts off the waterworks. I guess you could say that it gives me a feeling of well-being. But that is me. I've seen others like me, but some people say that it makes them more depressed. I guess a lighter version of Tegretol is Trileptal (oxcarbazepine) but that may or may not work as well. I don't know since I never took Trileptal. The only drawback to me from Tegretol was that the dosages of many of my meds needed adjusting upwards.

Of course, I can't say enough good things about Abilify. Abiilfy is the only med that has touched my apathy and anhedonia and lack of motivation. I am semi-functional today due to Abilify. I like Abilify so much, I could probably do a commercial for it because it just works for me. I do think that it works well with my citalopram even though I don't think antidepressants do much on their own. I did take Risperdal years ago, and it helped me subtly at a bad point in my life, but I took it again (generic this time) and it didn't do anything for me. No side effects but no help either. But even when it did work, it was not in the same league as Abilify. It mostly helped me make plans and get my life back on track.

Edited by jt07
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3 hours ago, jt07 said:

Keep in mind that none of us are doctors and we can't tell you what to do.

 

Duly noted. Thanks for your response!

3 hours ago, jt07 said:

The backbone of my cocktail is carbamazepine (Tegretol). While I can't say it makes me "undepressed," it does keep me out of the pit and also it shuts off the waterworks. I guess you could say that it gives me a feeling of well-being. But that is me. I've seen others like me, but some people say that it makes them more depressed. I guess a lighter version of Tegretol is Trileptal (oxcarbazepine) but that may or may not work as well. I don't know since I never took Trileptal. The only drawback to me from Tegretol was that the dosages of many of my meds needed adjusting upwards.

I have heard this of carbamazepine and considered asking about it, the only thing about it is that it is a CYP inducer, and would definitely require dose increases of my meds, especially Zonegran (which I don't know if my pdoc would be willing to make since she has been pretty adamant about keeping me at 300 mg). That'd be the only hangup about it though, that and I've heard it can cause weight gain—I'm already overweight and trying to lose weight, and weight gain is a nono for me. Then again, I've heard it can be one of the more weight neutral ones.

I've taken oxcarbazepine before, but only in low doses (150 mg), my pdoc seemed not to want to give me any high doses of it to me, I think because she didn't want it to depress me since it's typically used more as an antimanic, but I've read about it having antidepressant and anxiolytic properties as well. It also has a lighter side effect profile than carbamazepine, which makes it slightly more appealing, but I haven't seen the same antidepressant-stabilizing properties as I've seen in others who've taken carbamazepine.

This will definitely be something I will bring up. Thanks. :) 

3 hours ago, jt07 said:

Of course, I can't say enough good things about Abilify. Abiilfy is the only med that has touched my apathy and anhedonia and lack of motivation. I am semi-functional today due to Abilify. I like Abilify so much, I could probably do a commercial for it because it just works for me. I do think that it works well with my citalopram even though I don't think antidepressants do much on their own. I did take Risperdal years ago, and it helped me subtly at a bad point in my life, but I took it again (generic this time) and it didn't do anything for me. No side effects but no help either. But even when it did work, it was not in the same league as Abilify. It mostly helped me make plans and get my life back on track.

 

Abilify was strange for me, at 2 mg it had a wonderful effect on my mood at first, then I was down in the dumps. Then we tried 5 mg and my mood lifted very briefly, but then I became even more depressed, so we went back down to 2 mg, which sort of helped, but I was still pretty down. Eventually, we went back up to 5 mg, which sort of made me feel numb. I read that 10-15 mg tends to be where most people's "sweet spot" is with Abilify, so I pushed (a little too quickly) for us to raise it to 10 mg, which helped quite a bit, and I should've left it there, but I just had to push it to 15 mg "just in case," which is when all hell broke loose with some of the worst akathisia I've ever experienced, pacing over 5 miles per day according to my Fitbit, and my mood was excruciatingly miserable. My pdoc was out of town, but called me to check on me because she had a "bad feeling" about me, and was she ever right! (I had been having a rough time at that point and was seeing her on almost a weekly basis.) She told me to quarter the 15 mg, so I just got my 5 mg and halved them, which made the akathisia go away, but my mood was in the pits again. I think I pushed it too much too fast, and probably should've just stayed at 10 mg really in retrospect.

I'm glad Abilify has had such a profoundly positive effect on your life! :D

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Thank you. Yeah, Abilify is one of the few psych meds that worked for me like the commercial said it would. But of all the meds in my cocktail, the one that I absolutely cannot give up is carbamazepine so that should tell you how much it helps me. I forgot to mention that carbamazepine completely got rid of any serious suicidal ideation. It also has some side benefits like getting rid of 95% of my headaches and getting rid of a lot of pain. I mean, the few times I went off it, I realized that I had pain (mostly joint) that I didn't even know that I had. It's almost as if my brain needs the carbamazepine. I don't have any significant cognitive impairment from the carbamazepine either.

It's too bad about the Zonegran, but maybe if you show your pdoc (in the PI sheet) that carbamazepine lowers the amount of Zonegran in the blood she might go above 300 mg.

Again, I'm not saying it will work for you. It's just been a miracle med for me. It is definitely a YMMV med.

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I got out my Abilify I had leftover and decided to give it a try because the Latuda is definitely making me more depressed. I took it for a short while before I visited my pdoc, and at that time, as well as now, I notice right off the bat that for some reason, this time around, Abilify makes me very bellicose and ornery... I'm always very snarky and argumentative with everyone, and generally just have a shitty, unpleasant demeanor. It definitely quickly lifted me out of the depression I was in, but I don't like the person I am when I'm on Abilify, so I have to think of something else.

I found out my insurance company also put ALL  of the brand-name antipsychotics on step-therapy and are holding me to that even though I have on my history where I've taken generic Abilify and Geodon, as well as Haldol, Stelazine, Prolixin, and Thorazine (they probably don't count the typical antipsychotics though). So unless I go to the trouble to call my insurance company and contest with them that I've already taken generic antipsychotics, which will likely be unproductive, I'm limited to the generic-only AAP's. My pharmacy sent a request for my pdoc to fill out a PA, but her office is terrible about following through with those and I've almost never gotten a PA to go through with them, I've had to just go to my GP and get him to prescribe me the medicine so their office staff gets the PA done (usually gets it done within a day or two, and the PA clears a day or two after that).

So I have to figure out something else...

  • I strongly dislike the caloric requirements with Geodon, plus it makes me gain weight, otherwise I'd be on it because it actually works pretty well. It's on my list though. The caloric requirements would probably force me to eat healthily at least...
  • Regular Seroquel (not XR, that's on step-therapy T__T) is noteworthy since Seroquel is known for kicking depression's butt, but DAT WEIGHT GAIN THO. I've heard regular Seroquel's weight gain is worse than XR's weight gain (which I've heard is still prominent, but my pdoc insists she doesn't see weight gain on Seroquel XR). I'd only be on the 300 mg dose (the antidepressant dose), but that's still plenty to cause weight gain. Does anyone have any experience with regular Seroquel at this dose and any insight into weight gain?
  • Risperdal at low doses I hear has decent antidepressant properties. Anecdotally, I've heard 0.5-1 mg is sufficient for antidepressant effects and causes no side effects, not even weight gain (at that dose). I've heard that weight gain from Risperdal, though, isn't is instantaneous as it is with other AAP's, it's more gradual and occurs over a longer period of time (I think it was secondary to increase in prolactin?). Any experience with Risperdal having antidepressant effects? What dose were you at? Any weight gain?
  • Invega has apparently gone generic recently... does anyone have any experience with it having antidepressant properties? What dose? Side effects/weight gain?
  • Zyprexa is sort of a last resort drug to me due to its weight gain and diabetogenic properties (I'm fighting prediabetes), but I do hear it can knock the hell out of depression, and is approved for depression.

 

I absolutely hate Fetzima... it doesn't work throughout the whole day, leaving me dysphoric and weepy as early as 1 PM... there's something terribly wrong with the extended release delivery system with this medicine. I've even felt withdrawal symptoms in the middle of the day on some days. I need to find an antidepressant that works, and I think I'm going to turn back to the tricyclics.

  • The one I'm looking the most at is Anafranil (clomipramine). I've read it's the most effective TCA, and that it's not just effective for OCD (which I have), but also for treatment-resistant depression too, and the best one for it (along with Parnate (tranylcypromine)). I am, however, afraid of weight gain from it, which is apparently a prominent side effect (though I've heard it can cause weight loss and appetite loss too). I've heard it's pretty sedating, but honestly, I could use some sedation as lately I'm only getting about an hour of sleep every night with some naps during the day (nothing to do with my stimulant as I was off of stimulants for a little while and I was the same way). Can anyone share there experiences with Anafranil re: effectiveness, side effects (incl. weight gain), etc.?
  • The other thing I'm considering is a secondary amine TCA (more noradrenergic) + SSRI combo to create a more balanced SNRI-like effect than what the current SNRIs have to offer.
    • The most commonly used combination I hear is nortriptyline (Pamelor) and sertraline (Zoloft), but these two meds have both proven ineffective for me (the latter was effective at first but eventually pooped out).
    • Norpamin (desipramine) + SSRI: I'd be less concerned about many side effects with this one, but my pdoc has insisted that this is a risky med to try, especially with stimulants. I've brought it up to her a number of times, but we always ultimately go another route. Anyone have any experiences with desipramine they can share?
    • Ludiomil (maprotiline) + SSRI: I know this is a tetracyclic, actually, but I'm still interested in it because it's a highly selective NRI. It is however highly antihistaminergic, and thus prone to causing weight gain. Anyone have any experiences with maprotiline they can share?
    • (Vivactil (protriptyline) + SSRI): I've taken this one before, had little side effects from it except that it became far too anticholinergic for me (loss of closeup vision and urinary retention). It's said to be stimulating, but I found it to be hardly stimulating, then again I was only on 30 mg/day, half the max dose (my pdoc insisted the max was 40 mg/day, which I've seen in some psychopharmachology textbooks, so I dunno...).
    • (Strattera + SSRI): Okay I know this isn't a TCA, but it is a highly selective NRI. I've done this before too, though, I took 40 mg with Zoloft, and found it to be ineffective, but maybe a higher dose with a different SSRI would be more effective. Not worried about any side effects with this one.
  • Tofranil (Imipramine): heard mixed things about its effectiveness, but I know I'd be getting two meds in one, imipramine + desipramine. Can anyone share anything on imipramine? (effectiveness, side effects, weight gain, sedation)
  • Elavil (amitriptyline): last resort of the TCAs, heard mixed things about its effectiveness too, but that it's generally one of the more effective ones. I was ready to call bullshit on my pdoc when she told me she doesn't see much weight gain with this one. I know this one can cause massive weight gain, but I guess maybe she was trying to convince me to get on something that was actually effective and that doesn't pussyfoot around. I know it's sedating, and know it has a propensity for weight gain, but can anyone share their personal experiences with it?

 

I'm definitely going to ask about carbamazepine, but I notice there's a form of it, Equetro, an extended release version of it, which is specifically indicated for bipolar disorder. Has anyone found any form of carbamazepine, in particular, to be superior for bipolar depression benefits? Or is regular old carbamazepine just fine?

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I'm not bipolar, but regular old carbamazepine has worked fine for me.

There are a few points in your post I'd like to address. The first time I took Risperdal (the brand) I was getting samples from my pdoc and then Risperdal went generic and the samples dried up. So my pdoc switched me to Invega (which was the new patent extender for Risperdal). I did not get the same effect from the Invega that I got from Risperdal so I eventually wound up giving it up. But that might just be my experience, However, given the choice, I'd go with the Risperdal.

Anafranil ... I took it ... years ago. What I can say about it is that it definitely felt like a tricyclic. It was sedating and zombifying and really messed with my sense of time. I really hate the tricyclic ADs. Norpramin caused me to loose a summer when I was a teenager because I was so dizzy I was constantly nauseous. It was like having constant seasickness. I won't say more because I'm sure these meds help a lot of people,

 You had a very interesting experience with Abilify. I wonder if maybe it was a combination that caused you to change or whether just the Abilify alone. I know that meds that hit NE hard can cause of lot of those issues, and Abilify might be able to amplify it. In any rate, it does go to show that we all react differently to these meds.

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23 hours ago, jt07 said:

However, given the choice, I'd go with the Risperdal.

Duly noted. Thank you!

23 hours ago, jt07 said:

Anafranil ... I took it ... years ago. What I can say about it is that it definitely felt like a tricyclic. It was sedating and zombifying and really messed with my sense of time. I really hate the tricyclic ADs. Norpramin caused me to loose a summer when I was a teenager because I was so dizzy I was constantly nauseous. It was like having constant seasickness. I won't say more because I'm sure these meds help a lot of people,

 

Wow, that all sounds pretty terrible. I'm having reservations about trying either of those TCAs now, but then again, I know everyone is different.

I've actually made some reconsiderations in the "remodeling" of my cocktail. (get to that in a sec)

23 hours ago, jt07 said:

You had a very interesting experience with Abilify. I wonder if maybe it was a combination that caused you to change or whether just the Abilify alone. I know that meds that hit NE hard can cause of lot of those issues, and Abilify might be able to amplify it. In any rate, it does go to show that we all react differently to these meds.

 

Well, Abilify as far as I know is well known for causing akathisia. It was definitely one of the best AAPs for my mood, if only the benefits were sustained.

What exactly do you mean by "meds that hit NE hard can cause [a lot] of those issues, and Abilify might be able to amplify it?" Are you talking about my combining it with Cymbalta at the time (did I even mention that?)? In what way would Abilify amplify it?

Indeed, all of our brain chemistry is vastly different.

 

So the modification I was thinking about making was as follows:

  • Prozac 40-80 mg or Zoloft 200 mg (not sure about the Prozac since I hear it take forever to start working
  • Strattera 100 mg (titrating up to it of course)
  • Wellbutrin XL 300 mg (I've been taking XL 150 mg lately on my own accord out of desperation, and am ready to titrate up to 300 mg)
  • Rexulti 2 mg (assuming my GP has samples with the 1 week of 0.5 mg and 1 week of 1 mg, otherwise I can just ask him to prescribe me 1 mg and split them in half for a week and then take 1 mg until my pdoc appointment)
  • Desoxyn 20 mg div bid

The reason for combining Prozac or Zoloft with Strattera is to create a customizable ratio of SNRI action (as opposed to the fixed ratio of the SNRIs currently on the market), plus Prozac disinhibits norepinephrine and dopamine via 5-HT2C antagonism, which w/ Strattera would have a trimonoaminergic effect; with Zoloft, it has mild affinity for the dopamine transporter, thus it exhibits slight dopamine reuptake inhibition, which combined with Strattera, would yield trimonoaminergic reuptake inhibition. There have been case reports and studies using Strattera for depression in augmentation with SSRIs.

Wellbutrin would further augment the NE-ergic and DA-ergic effects from Prozac and the NE-ergic effects from Strattera, or further augment the DA-ergic effects of Zoloft and the NE-ergic effects of Strattera.

Regarding the Rexulti (which I've taken before but only briefly), I spoke to my insurance company, and as long as the doctor fills out on the PA form that I have taken the generic products in the past, and/or that I can't tolerate them (in my case both), then it should go through. The pain in the ass is that the PA only lasts for 3 months the first time, then for 6 months the second time... but still. My GP office is much better at handling PAs than my pdoc's office. I still have yet to hear back about the Latuda I was prescribed...

If my GP doesn't feel comfortable prescribing Desoxyn, I have a few backup ideas in my pocket (Zenzedi, Evekeo, Adzenys XR-ODT).

He's really good about working with me with meds and is really open to suggestions. I'd get a work in with my pdoc, but it wouldn't be until next week or longer before I get one (I don't remember if I've already said that or not), and I just can't wait that long.

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8 hours ago, mikrw33 said:

What exactly do you mean by "meds that hit NE hard can cause [a lot] of those issues, and Abilify might be able to amplify it?" Are you talking about my combining it with Cymbalta at the time (did I even mention that?)? In what way would Abilify amplify it?

 

I just mean that it's been my experience that meds that hit NE hard can cause the symptoms you were describing, namely being bellicose and irritable. This is why I can't take Wellbutrin, super high doses of Remeron, or even Cymbalta. As far as the Abilify goes, I was just guessing that it must somehow combine badly for you with some of these ADs. It's just a guess because I can't see how Abilify alone could cause the symptoms you describe. But, as I said, we all react differently to these meds and maybe that's just your reaction to the Abilify.

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Oh I see, gotcha. Well, I've never had any problems with any noradrenergic meds. In fact, they usually relax me on account of my ADHD. The only thing I can think of is the 5-HT2C partial agonism of Abilify, which tends to act more like an antagonist in the presence of high serotonin levels I've read, but an agonist in low serotonin levels from what I've read, so if my serotonin levels are low and it's acting like a 5-HT2C agonist, maybe it's inhibiting norepinephrine and dopamine release and causing strange behavior in me? Either that or it's the dopamine partial agonism, which for some reason this time around I'm just very sensitive to or something and it's causing me to act irritably.

Abilify, in general, is quite a stimulating antipsychotic for most people, especially in the lower doses to my understanding. It was stimulating to me before, but not in a bad way. Maybe it's inducing a mixed state for some reason... I have no clue. All I know is I quit taking it today. I started taking some Rexulti I had leftover, and hopefully my GP can get me approved for some Rexulti. If not, I think I'm honestly going to go for Zyprexa (probably just 5 mg). I mean, I'm only going to be taking this for a month, maybe 2 months tops... so there's almost no way I can get diabetes from it, and the weight gain will probably be minimal in that amount of time if I stay on a low carb diet, perhaps even if I get back on a ketogenic diet.

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2 hours ago, notloki said:

I am not sure if I missed something but if you are planning on making all those changes at once you will never be able to sort out what is causing a problem or side effect.

this. you can debate forever what is agonist of what, but in the end you are a person, not a chemical soup.

if you are getting ECT soon, you shouldn't worry about figuring out what you should take now. wait until after the ECT at least. ECT helps me a lot and i've been looking into maintenance treatments, because it seems like it's the only thing that helps. to each his own.

depression and bipolar are holistic diseases. for me, it helped to look at my life and what i could improve in it as opposed to simply wondering what's gonna antagonize what the most in my brain.

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I have a bad tendency to debate and obsess about things like this as I have OCD, and I don't really realize I'm doing it until someone calls me out on it, so thanks for pointing it out to me. It's just that it could be a month or two months before my ECT begins, and I don't want to be stuck with shitty meds that aren't working at all when I could be on meds that at least partially work for me in the meanwhile.

I haven't had the ECT yet, so I don't know if it's going to work for me, but if it does work, I have a feeling that maintenance treatments will probably be what keeps me in or near remission. I've also not tried Parnate yet (which is what my pdoc has in mind after ECT), so I'll give that a chance first.

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If you are getting ECT in 1 to 2 months, I would not make any AD changes because it will just be reaching its full effect by the time you do ECT and you might get pulled off it. I'd go for changes in the faster acting meds and worry about ADs when you discuss maintenance treatments.

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On 8/8/2016 at 8:49 PM, jt07 said:

If you are getting ECT in 1 to 2 months, I would not make any AD changes because it will just be reaching its full effect by the time you do ECT and you might get pulled off it. I'd go for changes in the faster acting meds and worry about ADs when you discuss maintenance treatments.

 

While I agree, the Fetzima and Latuda was literally unbearable.

I saw my GP today because it would take too long to see my pdoc and he prescribed me a combination of fluoxetine and desipramine based on the following study.

http://www.ncbi.nlm.nih.gov/pubmed/2009031

I'm going to follow up with my pdoc as soon as possible to tell her about my med changes and to see if she's found anything out about a pdoc who can administer all the ECT sessions.

 

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