Posted by Elizabeth on January 9, 2000, at 20:41:36
In reply to Re: Parnate "properties" :), posted by Scott L. Schofield on January 9, 2000, at 20:08:55
> > I guess my next question is obvious. If you are so convinced that you are not bipolar, why have you been taking lithium at all.
I started it to augment Parnate. I'm pretty sure I've discussed this here before: I was nondepressed but still had anhedonia on Parnate, added 600mg of lithium and suddenly I was enjoying going out, eating, sex, music, etc. again. Now I'm trying tapering off the lithium to see if I can manage without, because of the attention side effect.
There's no evidence that verapamil augments ADs in unipolar depression, some evidence that it doesn't, and I think there have even been reports of it triggering or exacerbating depression. See why I'm a tad concerned?
> I am *sure* that using lithium to augment antidepressants in unipolar depression is often a successful strategy.
I'm a walking testament to this!
> If this has been the rationale for using it, would not this rationale also apply to other “mood-stabilizers”?
Nope. Depakote didn't do a thing when I took it with Parnate. They're not all identical, and lithium is by far the best-studied.
> I imagine if you were bipolar, mania would probably have made an appearance by now.
It did, when I was taking Effexor, but it was in the context of serotonin syndrome. I think I may have been a tad hypomanic (mixed) on Paxil.
> Also, your presentation of depressive vegetative symptoms doesn’t seem to fit very well into the typical bipolar profile.
What is the "typical bipolar profile?"
> Severe depression began with me when I was 17. My initial diagnosis at age 22 was determined to be atypical unipolar. I tried an awful lot of drugs between then and age 27. As I guess you know by now, my depressed state has been quite severe and unrelenting. During this time, I can count on two hands the number of days in which I experienced a transient improvement. Never did I experience mania. However, I experienced a robust and steady remission of depression brought about by a combination of Parnate with Norpramin.
How was that combination for you? Any side effects? Do you recall what doses you were on?
> I spent about six months in a state of euthymia, or something close to it, after which things began to change. Hypomania appeared and later blossomed into a psychotic manic dysphoria.
Ow. Mixed mania is the most horrible mood state, I think.
> I don’t want to discuss what happened with subsequent therapy, but I think it is important to note that the doctor I was seeing did not perceive this episode as being a diagnostic criterion for bipolar disorder. He continued to treat me as if I were unipolar, and thus I never received any “mood-stabilizers” that now seem necessary if I am to have a chance to get well.
Manic episodes that happen when you're taking antidepressants aren't supposed to count towards a diagnosis of bipolar disorder, no. But some people who don't have spontaneous manic episodes nevertheless become manic on ADs...in these cases ("bipolar III" is a term I've heard used by researchers and clinicians -- I've never heard the list you mention except posted on the internet), a mood stabilizer seems indicated.
> I have no reason to believe, and certainly don’t suggest that you are in any way bipolar. I know very little about your treatment history, but I get the impression that your depression is quite episodic.
Yes, it is.
> Have you ever been successfully treated?
Sure. MAOIs work well for my depression, but I also have what my pdoc describes as "ADD spectrum disorder" and that has been causing me a lot of trouble. I also have some irritating problems with MAOI side effects: Parnate causes spontaneous hypertensive episodes while Nardil and Marplan cause sugar cravings and weight gain!
> Also, I agree with Dr. Kupfer at Western Psychiatric that there is no such thing as a maintenance dose of an antidepressant.
Yeah, I think that is an old idea that has since been discarded. (Some older books I've seen recommend going down to 15mg of Nardil once you've responded!)
poster:Elizabeth
thread:17762
URL: http://www.dr-bob.org/babble/20000101/msgs/18496.html