![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 3 to 27 of 43. Go back in thread:
Posted by med_empowered on November 17, 2005, at 17:52:37
In reply to Re: When the options are gone?, posted by Squiggles on November 17, 2005, at 16:57:33
hmmm...depending on the insurance benefits, I'd probably try to get a therapist, a psychiatrist (a GOOD one), and a pscyhopharmacologist..you'll probably also want to do extensive lab work to exclude conditions mimicking depression. In EXTREME cases, psychosurgery is an option, but I wouldn't recommend it *at all*. Sometimes going med free actually helps people...treatment-resistant schizophrenics, for example, are sometimes given a neuroleptic-free period when all else fails. Good luck.
Posted by Phillipa on November 17, 2005, at 22:37:17
In reply to Re: When the options are gone?, posted by med_empowered on November 17, 2005, at 17:52:37
Med, I didn't know this. Fondly, Phillipa
Posted by blueberry on November 18, 2005, at 5:29:08
In reply to When the options are gone?, posted by Bob on November 17, 2005, at 16:31:29
Cocaine makes almost anybody feel good...I'm not suggesting it at all...but ritalin is very similar...have you tried the stimulants like ritalin?
Have you tried mood stabilizers alone without antidepressants in the mix?
Have you tried ssri + naltrexone? (the opioid-serotonin connection for treatment resistance and for ssri poopout)
Have you tried low dose amisulpride? (mailorder) Have you tried tianeptine?(mailorder) In your situation, I would not hesitate to use overseas meds, some of them are fantastic and are very popular across the globe everywhere except USA.
I could be wrong, but I'm not sure all the options are gone.
Posted by denise1966 on November 18, 2005, at 12:03:27
In reply to Re: When the options are gone?, posted by med_empowered on November 17, 2005, at 17:52:37
Hi,
Why would you not recommend psycho-surgery, surely if so much has failed something like "deep brain stimulation" would be worth a try?
Denise
Posted by Bob on November 18, 2005, at 17:35:39
In reply to Re: When the options are gone?, posted by blueberry on November 18, 2005, at 5:29:08
> Cocaine makes almost anybody feel good...I'm not suggesting it at all...but ritalin is very similar...have you tried the stimulants like ritalin?
>
> Have you tried mood stabilizers alone without antidepressants in the mix?
>
> Have you tried ssri + naltrexone? (the opioid-serotonin connection for treatment resistance and for ssri poopout)
>
> Have you tried low dose amisulpride? (mailorder) Have you tried tianeptine?(mailorder) In your situation, I would not hesitate to use overseas meds, some of them are fantastic and are very popular across the globe everywhere except USA.
>
> I could be wrong, but I'm not sure all the options are gone.I would say, looking back on my history that, I fear pretty much all the options are gone, except maybe MAOIs. I've tried every SSRI class drug with the exception of Cymbalta, which is already gaining a nasty rep for withdrawl. I had enough of that with Anafranil and Effexor, which were extremely challenging. I've tried mood stabilizers: Depakote, Tegretol, etc, as well as drugs like Topomax (I almost bought it on that one), Lamictal, Neurontin, Trileptal, and probably some I'm forgetting. I've augmented with stimulants, both typical and atypical, such as Ritalin and Provigil. These worked for about 2 days, and all benefits disappeared and I was left with fatigue and breathing problems. I've also tried thyroid hormone augmentation. And yes, unfortunately, I had 21 fun-filled ECT sessions which left me feeling, in the end, somewhat like what happened after Topomax, except eventually worse after I stopped. It's weird, those last two treatments did some good things in the beginning and brought some hope, but looking back and taken as a whole, they were absolutely disasterous and life threatening. I am well aware of course, that these responses are peculiar to me. In fact, when I first took these meds years ago, not only did I respond differently to them, but my symptoms were a fraction of what they are now. I have had at least two breaks of being off all meds, and they were not good times. Currently I'm only taking Lithium with a touch of Klonopin. I'm an not in good shape, and instead of stabilizing I'm degenerating. Not a good situation. I may end up in the hospital soon, but I hear that they only take you if you are suicial, and there only goal is to hear you say you're currently not, and then they discharge you. That doesn't sound very helpful to me, as anyone can slap some nasty sedating psychotropic on a patient and then send them on their way. I guess there's VNS, but I don't know why that wouldn't end up disasterously also, and besides, I don't know if I have the 2 years to wait and see if I'm one of the lucky few for which it seems to work.
I do currently have a therapist and a longtime psychiatrist. In fact, I just had a discussion with my therapist last week about whether I should keep seeing her, as it is obvious nothing much can be said at this point. However, we agreed it was at the very least cathartic.
I got a complete physical checkup and all kinds of blood work, along with an MRI about 2 months ago. The tests came back that I am robustly, and rampantly healthy. Of all the tests that were done from the 6 to 8 vials of blood they took, the only thing of any note was a slight elevated cholesteol level, but the doc said it was nothing at all to worry about.
I imagine psychosurgery might not be a good option in some peoples' opinion because it is utterly unreversible. What every happens after that, well, that's what you've got for the rest of your life. I've never heard any of my doctors bring it up.
I've never heard of the SSRI + naltrexone idea. Sounds interesting.
I have not tried amisulpride or tianeptine, but how would I get those without a scrip, and what if my supply got interrupted? Besides, I thought I remembered see posts on here about those two things not really being that effective? Maybe I'm remembering something else.
I think I'm finally at the end of the road here, and it seems to me that my body just cannnot tolerate these meds, not to mention that they don't work for the most part. I'll probably be limping along as long as I can on some barely tolerable med. Kind of ironic: when I first started posting on this forum, quite a number of years ago, I used to read posts of people who were much sicker than I, and almost reflexively think, well at least I'm not that bad. Now, I'm in almost the worst condition of anyone I know, whether it's on this board or not. That's probably an exaggeration, but not by much. I haven't been out of the house in days.
It's just stunning to me, upon reflection, that this has gotten so debilitating, and brutal, and that the medical community knows so utterly little about what is going on. I guess there are a number of other diseases out there like that, but don't it seems that the "imbalance of chemicals" theory is really, really vague.
Posted by linkadge on November 18, 2005, at 19:18:50
In reply to Re: When the options are gone?, posted by Bob on November 18, 2005, at 17:35:39
I saw a TV special on the SST stereotactic subcaudate tractononomy. It was supposedly very effective. The individuals followed were very satisfied, they said they felt like themselves but with extrordinarily less intensity to their emotions.
Not like a lobotomy, differnt part of brain.
Linkadge
Posted by 4WD on November 18, 2005, at 22:29:26
In reply to Re: When the options are gone?, posted by Bob on November 18, 2005, at 17:35:39
Wouldn't it be worth giving an MAOI a try? I've always kind of held that in reserve for myself as a last resort. Sounds like you're at that point.
And I think you are probably right about the hospital. What does your pdoc say? Have you discussed opiate therapy with him/her?
Marsha
Posted by Bob on November 19, 2005, at 0:38:19
In reply to Re: When the options are gone? » Bob, posted by 4WD on November 18, 2005, at 22:29:26
> Wouldn't it be worth giving an MAOI a try? I've always kind of held that in reserve for myself as a last resort. Sounds like you're at that point.
>
> And I think you are probably right about the hospital. What does your pdoc say? Have you discussed opiate therapy with him/her?
>
> Marsha
I might give the MAOI a try. It's just that the washout period practically guarantees that I will have to endure weeks without meds. That's scary. Also, I haven't heard great things about them anyway, like Nardil causing massive weight gain and flawless chemical castration. I know I should n't be weighing these things against my life, but when you finally do get on a drug and pick up up 80lbs and go numb in your genital area, it just adds to the misery - especially if the drug doesn't work. I guess I'm just afraid of drugs anymore. They have led to much misery and I don't know how I can last a long time on any of them. When I look back, I didn't take any drug for more than a year before ultimately tapering off in a desperate attempt to reduce misery caused by side effects.What exactly is opiate therapy? That causes me to imagine being stuck in a methadone-type clinic somewhere. Is there a website or something where I can check it out?
Posted by Bob on November 19, 2005, at 0:41:10
In reply to Re: When the options are gone?, posted by linkadge on November 18, 2005, at 19:18:50
> I saw a TV special on the SST stereotactic subcaudate tractononomy. It was supposedly very effective. The individuals followed were very satisfied, they said they felt like themselves but with extrordinarily less intensity to their emotions.
>
> Not like a lobotomy, differnt part of brain.
>
>
>
>
>
> LinkadgeI guess I'll have to do some research, but man it sounds scary. Is that something they perform for severe depression? My disease has progressed so far beyond just thought problems. It is a very physical disorder now - just as much so as mental.
Posted by Bob on November 19, 2005, at 0:41:48
In reply to Re: When the options are gone?, posted by linkadge on November 18, 2005, at 19:18:50
Thanks for the responses, everybody.
Posted by ed_uk on November 19, 2005, at 8:11:55
In reply to Re: When the options are gone? » linkadge, posted by Bob on November 19, 2005, at 0:41:48
Bob,
IMO, you really need to try an MAOI. Nardil and Parnate are really quite different - if one doesn't work the other can still work very well.
Since psychosurgery was mentioned, here is an interesting website which describes the various forms of surgery. I'm not recommending surgery, I just thought you might be interested.
http://www.dundee.ac.uk/psychiatry/research_mood_nmd.htm
Kind regards
Ed
Posted by Sebastian on November 19, 2005, at 14:13:52
In reply to Re: When the options are gone?, posted by Bob on November 18, 2005, at 17:35:39
Have you tried anti psychotics, like zyprexa.
Posted by Bob on November 19, 2005, at 15:58:11
In reply to MAOIs and psycho-surgery » Bob, posted by ed_uk on November 19, 2005, at 8:11:55
> Bob,
>
> IMO, you really need to try an MAOI. Nardil and Parnate are really quite different - if one doesn't work the other can still work very well.
>
> Since psychosurgery was mentioned, here is an interesting website which describes the various forms of surgery. I'm not recommending surgery, I just thought you might be interested.
>
> http://www.dundee.ac.uk/psychiatry/research_mood_nmd.htm
>
> Kind regards
>
> Ed
>
>
>
>
>
>
I haven't ruled them out. If my psychiatrist told me that's what I needed to try, then I guess I'd do it. He never forces anything on me though. I just can't imagine being on such a heavy duty medecine like that for the rest of my life. I mean, does anyone really take these things for decades, or does it always end up bad in the end? I also can't imagine being on a super-restrictive diet for a very long time. The last thing I need is a stroke. I wonder, if the MAOIs had remained a first line treatment if the drug companies would have found safe versions by now.Thank you for the website.
Posted by Bob on November 19, 2005, at 16:02:24
In reply to Re: When the options are gone?, posted by Sebastian on November 19, 2005, at 14:13:52
> Have you tried anti psychotics, like zyprexa.
I took Geodon once, and literally hours after one dose, I got extremely agitated and panicky, at which point I promptly called my psychiatrist's emergency number for advice/scrips. I have not tried any of the other anti-psychotics. Is Abilify one of these?
Hasn't Zyprexa run into problems for causing extreme weight gain and diabetes? I see ambulance-chaser lawyer ads on TV now and then, and one of them talks about Zyprexa of all things. I mean, there's a lot of dangerous drugs out there, why would they mention Zyprexa?
Posted by ed_uk on November 19, 2005, at 16:11:43
In reply to Re: MAOIs and psycho-surgery » ed_uk, posted by Bob on November 19, 2005, at 15:58:11
Hi Bob
>I just can't imagine being on such a heavy duty medecine like that for the rest of my life. I mean, does anyone really take these things for decades.......
Yes, there are people here who've taken them for many years. They're not necessarily heavy duty - some people have few side effects. Other people have lots of side effects, you'll have to try them and see for yourself.
>I also can't imagine being on a super-restrictive diet for a very long time.
The modern MAOI diet isn't super-restrictive. Here is some more information........
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8617704&dopt=Abstract
Regards
Ed
Posted by Jedi on November 19, 2005, at 17:02:45
In reply to Re: MAOIs and psycho-surgery » ed_uk, posted by Bob on November 19, 2005, at 15:58:11
>I just can't imagine being on such a heavy duty medecine like that for the rest of my life. I mean, does anyone really take these things for decades, or does it always end up bad in the end? I also can't imagine being on a super-restrictive diet for a very long time. The last thing I need is a stroke. I wonder, if the MAOIs had remained a first line treatment if the drug companies would have found safe versions by now.
Thank you for the website.
Bob,
As a person that has been on Nardil plus augmentation for the good part of the last decade, I am having a hard time with your thinking on MAOIs. There is a school of thought that a person can not even be considered treatment resistant without a couple of five week trials on Nardil and Parnate. Without Nardil I would not be living right now. I do not know the history of your depression, but if it is atypical with social anxiety, an MAOI should have been the 2nd tier medication trial. It is not a last resort, it is the gold standard that other medications are compared to. The side effects and diet restrictions are way overblown. I plan on being on Nardil with various augmentations the rest of my life.
Wishing you Well,
Jedi
Posted by Bob on November 19, 2005, at 18:02:08
In reply to Re: MAOIs and psycho-surgery » Bob, posted by Jedi on November 19, 2005, at 17:02:45
> >I just can't imagine being on such a heavy duty medecine like that for the rest of my life. I mean, does anyone really take these things for decades, or does it always end up bad in the end? I also can't imagine being on a super-restrictive diet for a very long time. The last thing I need is a stroke. I wonder, if the MAOIs had remained a first line treatment if the drug companies would have found safe versions by now.
>
> Thank you for the website.
>
>
>
> Bob,
> As a person that has been on Nardil plus augmentation for the good part of the last decade, I am having a hard time with your thinking on MAOIs. There is a school of thought that a person can not even be considered treatment resistant without a couple of five week trials on Nardil and Parnate. Without Nardil I would not be living right now. I do not know the history of your depression, but if it is atypical with social anxiety, an MAOI should have been the 2nd tier medication trial. It is not a last resort, it is the gold standard that other medications are compared to. The side effects and diet restrictions are way overblown. I plan on being on Nardil with various augmentations the rest of my life.
> Wishing you Well,
> Jedi
>
>Jedi
Your info is heartening. I assume you are not getting extreme side effects, or otherwise you'd be off of it? If you don't mind me asking, what types of things did you augment Nardil with, assuming that none of the SSRIs are available?
Again, it's not that I am somehow against the MAOIs, just that I've had a bad time with so many meds for so long that I'm real skittish now.
I basically have major depression, major anxiety, and some obsessional/rumination problems. Most of the meds I've taken have affected me greatly in one way or another - it's not like I'm some sort of inert rock and completely insensitive to all meds. I've just never been able to find a med that helped with my mental (and now physical problems) while at the same time actually allowing me to function in life. My standards were much higher in the beginning. Now I just want to be able to get out of the house on a daily basis.
Posted by med_empowered on November 19, 2005, at 18:03:37
In reply to Re: MAOIs and psycho-surgery » Bob, posted by Jedi on November 19, 2005, at 17:02:45
hey! The reason I don't think psychosurgery i susch a great idea is b/c its irreversible and there haven't been any really *good* double-blind studies. I also have problems with destroying healthy brain tissue to alter personality and mood...the idea of brain damage as therapy repulses me. MAOIs aren't too bad, but I can understand people wanting to avoid them. Aurorix (moclobedmide, others) is a reversible MAOI w/ fewer problems. The dose has to be pretty high to get effects--apparently a bunch of studies made it seem ineffective b/c they used low doses. Plus, it can be used with tricyclics and I think SSRIs. Its available in canada, europe, asia...pretty much everywhere except the US. If you're in the US, your doc might go for finding a way to get it to you and then monitoring your progress. Its available in generic, so even if your insurance won't cover that the costs shouldn't be too bad (I would think..I dont really know, though). The most hardcore Antidepressant regimine I can think of would be an MAOI+Tricyclic+low-dose stimulant; with moclobemide, you could probably do this w/ minimal side effects (and if you can use provigil as the stimulant, that will also reduce side effects). Good luck!
Posted by pseudoname on November 19, 2005, at 20:59:44
In reply to Re: When the options are gone? » 4WD, posted by Bob on November 19, 2005, at 0:38:19
I think we're in similar positions. I go days without leaving the house. I've tried ECT and about 3 dozen med regimes plus lots of therapy etc. Almost nothing did any good. Right now I'm just starting opioid therapy with buprenorphine.
> What exactly is opiate therapy? ... Is there a website or something where I can check it out?
See Stoll's 1999 case studies reprinted here: http://www.dr-bob.org/babble/20010522/msgs/64652.html
The buprenorphine I'm trying is a weaker & more complex opioid. See "Buprenorphine Treatment of Refractory Depression" by Bodkin et al, Journal of Clinical Psychopharmacology, Feb 1995, vol 15, p 49-57: http://balder.prohosting.com/~adhpage/bupe.html
One huge Babble opioids-for-depression thread starts here: http://www.dr-bob.org/babble/20011015/msgs/81414.html.
Adding naltrexone (which acts on opioid receptors) to an SSRI may be a better bet if you've had at least *some* response to the SSRI already (e.g., weak or pooped-out).
It sounds like you're thinking now of an MAOI? If you also become interested in opioid therapy ("opioid" is a more inclusive term than "opiate"), I'd suggest going ahead with MAOI trials while you gather info and talk to your docs about opioids. They may initially be reluctant or unaware of the literature or even misinformed about the law. And if an MAOI works, well, it'd easier to get, anyway.
Posted by Jedi on November 20, 2005, at 1:50:44
In reply to Re: MAOIs and psycho-surgery » Jedi, posted by Bob on November 19, 2005, at 18:02:08
> Your info is heartening. I assume you are not getting extreme side effects, or otherwise you'd be off of it? If you don't mind me asking, what types of things did you augment Nardil with, assuming that none of the SSRIs are available?
>
> Again, it's not that I am somehow against the MAOIs, just that I've had a bad time with so many meds for so long that I'm real skittish now.
>
> I basically have major depression, major anxiety, and some obsessional/rumination problems.Hi Bob,
I do get side effects from the Nardil. I am on a fairly high dosage of between 75 and 105mg. Most of the side effects have gone away over time. I no longer get orthostatic hypertension. In fact Nardil will decrease borderline hypertension, so that if you are affected with this ailment, another med for this is probably not necessary.The main side effects that are still with me are carbohydrate cravings which cause my weight gain and delayed ejaculation. The weight gain can be controlled with vigorous exercise. When you are severely depressed, forcing yourself to exercise can be very difficult. Weight gain is also a symptom of my atypical depression. The delayed ejaculation has not been much of a problem for me, there are augmentations to handle this, also.
What it comes down to is a choice. I can fight though some minor side effects or lay in bed for 16 hours a day and watch my life and family disappear.
Currently, I am augmenting with 1mg of clonazepam. There is some current research that augmenting with up to 3mg of clonazepam can help resistant depression. I may try this for a month while reducing my Nardil dosage, just to see what happens. I've also augmented with nortriptyline which is the major metabolite of amitriptyline & effects mostly NE. I've used bupropion with Nardil also. This is officially contraindicated but helped with my Nardil induced weight gain. I found the bupropion caused some initial agressiveness but the Nardil counteracted the anxiety producing effects of bupropion. Never augment Nardil or Parnate with an SSRI. They potentiate serotonin in the brain by different pathways. Serotonin syndrome is the result. Anyway Bob, there are many things left to try. It can be a long hard road, but we do what's put in front of us.
Take care,
Jedi
Posted by linkadge on November 20, 2005, at 15:47:40
In reply to Re: MAOIs and psycho-surgery » ed_uk, posted by Bob on November 19, 2005, at 15:58:11
I don't mean to sound rude, but having to avoid a few types of food for an extended period of time seems to me to pale in comaprison to me to having to live with the kind of illness you're describing.
+ there are meds you can cary with you to abort hypertensive crisis.
Linkadge
Posted by Bob on November 20, 2005, at 16:52:23
In reply to Re: MAOIs and psycho-surgery, posted by linkadge on November 20, 2005, at 15:47:40
> I don't mean to sound rude, but having to avoid a few types of food for an extended period of time seems to me to pale in comaprison to me to having to live with the kind of illness you're describing.
>
> + there are meds you can cary with you to abort hypertensive crisis.
>
> LinkadgeDon't worry, I don't think your comment is rude, but I do think it can be misleading. I've heard that rationale many times, but once I'm on a medecine and presented with myriad side effects but still miserable, I then wonder why it's worth it. For example, both Effexor and Anafranil produced prodigious weight gain, inability to ejaculate, a lack of motivation, impaired ability to concentrate, profuse sweating, and so on. Most seriously, over time it got harder and harder to wake up in the morning, no matter what time I went to bed, until eventually I was not able to make it to work until mid-afternoon. Other SSRIs have done this also, but not quite to the same extent. I have tried many, many things to deal with this, but nothing, and no one has ever helped. So I have to wonder whether being on the med is worth it. About the only thing it does do is emotionally blunt me and, for the most part get rid of suicidality. What kind of life is that? I guess better than being suicidal.
The only way I ever got a girlfriend during all this time was when I stubbornly went of SSRIs and temporarily using Lithium with low-dose Celexa and Welbutrin. I achieved a small window where I had little motivation and was able to perform sexually (although poorly). The window soon faded.
Its easy to say that putting up with a few side effects is no big deal, but side effects coupled with ineffective meds is another issue. I think in my case, I am having bad reactions to meds, also. It seems that now, whenever I take a med with any SSRI action, I suffer physical effects, like general discomfort all over my body, especially after physical exertion, or exposure to heat, such as in a hot shower. It's a reaction that is very disturbing to me, yet no professional has ever even remotely suggested to me what it might be. This is one reason why I sough out meds like Topomax and Neurontin, as well as the ECT treatments. I've been desperately, desperately trying to find ways to subsist of meds. Not only have my efforts failed, but they have really, really close to bringing and end to everything. These were not issued I was dealing with way back when I first started these things. I guess many diseases evolve, or as I'd like to think, devolve.
Posted by Bob on November 20, 2005, at 20:06:25
In reply to Re: MAOIs » Bob, posted by Jedi on November 20, 2005, at 1:50:44
> > Your info is heartening. I assume you are not getting extreme side effects, or otherwise you'd be off of it? If you don't mind me asking, what types of things did you augment Nardil with, assuming that none of the SSRIs are available?
> >
> > Again, it's not that I am somehow against the MAOIs, just that I've had a bad time with so many meds for so long that I'm real skittish now.
> >
> > I basically have major depression, major anxiety, and some obsessional/rumination problems.
>
> Hi Bob,
> I do get side effects from the Nardil. I am on a fairly high dosage of between 75 and 105mg. Most of the side effects have gone away over time. I no longer get orthostatic hypertension. In fact Nardil will decrease borderline hypertension, so that if you are affected with this ailment, another med for this is probably not necessary.
>
> The main side effects that are still with me are carbohydrate cravings which cause my weight gain and delayed ejaculation. The weight gain can be controlled with vigorous exercise. When you are severely depressed, forcing yourself to exercise can be very difficult. Weight gain is also a symptom of my atypical depression. The delayed ejaculation has not been much of a problem for me, there are augmentations to handle this, also.
>
> What it comes down to is a choice. I can fight though some minor side effects or lay in bed for 16 hours a day and watch my life and family disappear.
>
> Currently, I am augmenting with 1mg of clonazepam. There is some current research that augmenting with up to 3mg of clonazepam can help resistant depression. I may try this for a month while reducing my Nardil dosage, just to see what happens. I've also augmented with nortriptyline which is the major metabolite of amitriptyline & effects mostly NE. I've used bupropion with Nardil also. This is officially contraindicated but helped with my Nardil induced weight gain. I found the bupropion caused some initial agressiveness but the Nardil counteracted the anxiety producing effects of bupropion. Never augment Nardil or Parnate with an SSRI. They potentiate serotonin in the brain by different pathways. Serotonin syndrome is the result. Anyway Bob, there are many things left to try. It can be a long hard road, but we do what's put in front of us.
> Take care,
> JediJedi
I feel deeply for you. I know exactly what you mean about a "long hard road". Not only that, but nobody can possibly imagine this plight who hasn't gone through it. I guess that's the way it is for other plights too. Still, the burden of this situation is unbelievably difficult, and to think that it's for life is just brutal. Ok, enough said.
It seems like it would be very difficult to tolerate Nardil along with Nortriptyline! Those are two heavy drugs. I didn't know that adding clonazepam would help depression. I thought benzos would only calm someone down, but that's it.
Are you saying that you have had success controlling your weight with exercise, that you have not been able to exercise because of your depression?
I assume that since you are taking a relatively high dose of Nardil and that you have augmented with different things that you experienced at least a partial fade out with the therapeutic effects of Nardil?
Bob
Posted by Jedi on November 21, 2005, at 1:51:22
In reply to Re: MAOIs » Jedi, posted by Bob on November 20, 2005, at 20:06:25
> It seems like it would be very difficult to tolerate Nardil along with Nortriptyline! Those are two heavy drugs.
Bob,
I only augmented with 100mg of nortriptyline. I had no additional side effects. There are quite a few controlled studies that show that an MAOI augmented with some tricyclics can be beneficial for treatment resistant depression. There are also some studies which show that augmenting with tricyclics can reduce the problems with ingested tyramine. The nortiptyline did not seem to add any additional benefit for me. So when I got my MAO inhibition up to a therapeutic level, I dropped the nortriptyline.> I didn't know that adding clonazepam would help depression. I thought benzos would only calm someone down, but that's it.
Many people on this board think that clonazepam causes worsening of depression. There have been some resent studies which show that at least 3mg of clonazepam added to an antidepressant can have a synergistic effect.
Example:
Nihon Shinkei Seishin Yakurigaku Zasshi. 2004 Apr;24(2):75-8.
[Clonazepam as a therapeutic adjunct to improve the management of depression]
Morishita S.
Depression Prevent Medical Center, Jujo Hospital, 32 Hattandacho, Kishoin, Minami-ku, Kyoto, 601-8325 Japan.Clonazepam, which is a benzodiazepine structurally related to chlordiazepoxide hydrochloride, diazepam and nitrazepam, has been available for the treatment of seizure disorders in the USA since 1976 and in Japan since 1981. Increasingly, clonazepam has been used in the treatment of a variety of psychiatric disorders. The effect of clonazepam on depression was first reported by Jones and Chouinard in 1985. Since their report, many investigators have reported on the antidepressive properties of clonazepam. A daily dose of at least 3.0 mg clonazepam in augmentation of ongoing antidepressant treatment should be considered in depression. Regarding clonazepam augmentation therapy, if a patient does not show improvement by the end of four weeks, the treatment regimen should be altered. Age at onset of the first depressive episode and a history of family psychiatric illness should be considered the predictor of prognosis. The author discusses specific guidelines for the use of clonazepam in depression.
> Are you saying that you have had success controlling your weight with exercise, that you have not been able to exercise because of your depression?My weight has gone up and down on Nardil. When I am able to exersise for an hour or two per day, the weight comes off. Without medication, my atypical depression makes it almost immpossible to exercise. I just can't force myself out of bed.
> I assume that since you are taking a relatively high dose of Nardil and that you have augmented with different things that you experienced at least a partial fade out with the therapeutic effects of Nardil?You assume correctly. I would call the level of depression that I suffer on Nardil, intermittent dysthymia. The augmentation that I try is to control this and the side effects. The two times I have been off Nardil in the past decade, I have regressed to major depression within a couple of months.
I have had partial responses with other medications. Effexor and Celexa combined with Wellbutrin SR have given partial response. The main problem with the SSRIs and SNRIs is a level of anhedonia and apathy which keep me from doing anything productive.
As mentioned before, I'm a lifer. I'm still hoping for that miracle medication to come along, but until then it is Nardil with augmentation.
Take care,
Jedi
Posted by Bob on November 21, 2005, at 15:32:05
In reply to Re: MAOIs » Bob, posted by Jedi on November 21, 2005, at 1:51:22
>
> I have had partial responses with other medications. Effexor and Celexa combined with Wellbutrin SR have given partial response. The main problem with the SSRIs and SNRIs is a level of anhedonia and apathy which keep me from doing anything productive.
>
> As mentioned before, I'm a lifer. I'm still hoping for that miracle medication to come along, but until then it is Nardil with augmentation.
> Take care,
> Jedi
>
>I did a stint on Effexor alone, as well as Celexa combined with Welbutrin SR. I too got a partial response from both, but the second one especially started producing unpleasant physical side effects, like breathing problems. One thing that makes these drugs hard for me is getting off of them when the situation turns sour. Effexor was nasty to get off of, and so was Anafranil. They were the worst. Oh, and benzos! Any change down in a benzo dose really hits me hard. It causes almost immediate suicidality.
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