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Re: Parnate and ?????

Posted by Elizabeth on April 12, 1999, at 9:40:10

In reply to Parnate and ?????, posted by David on April 11, 1999, at 5:56:03

Hi David.

I think this may have been different in the past, but "atypical features" can occur in both major depression and dysthymia. Some regard atypical depression as less severe than "typical" depression, but I don't know if I agree with this.

But anyway, in terms of treatment options...nortriptyline is not indicated for this sort of depression, except maybe if a number of other things have failed. The MAOIs and amphetamines are, as you've seen, better choices.

I notice you haven't tried the newer antidepressants (Prozac, Effexor, etc.). These might be worthwhile. Prozac has the longest track record, but it would be a problem if you found it didn't work and decided to switch back to the MAOI, so a shorter-acting SSRI might be a better choice. Effexor often works for people who don't respond to SSRIs.

In terms of MAOI augmentation, you might check out Dr. Bob's psychopharmacology tips site, as I think there are some ideas in there. It's Some things that I have heard of people using in combination with MAOIs are bupropion (Wellbutrin), thyroid hormones (e.g., Cytomel), lithium (which is an antidepressant as well as a mood stabilizer), anticonvulsants (less evidence than for lithium, but lamotrigine in particular is believed to be something of an antidepressant), buspirone (if you're going to do this, you *must* be able to monitor your BP, as increases have been reported), and pindolol.

The only antidepressants that I can think of offhand that definitely must not be used with MAOIs are SSRIs (including clomipramine) and Effexor. I'm not sure if there have been any problems combining them with other newer antidepressants (nefazodone, mirtazapine), but I personally wouldn't want to be the guinea pig in that experiment.

Good luck with things.




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